ACE inhibitors ‘protect against pneumonia’

Angiotensin-converting enzyme (ACE) inhibitors, but not angiotensin receptor blockers (ARBs), reduce the risk of pneumonia, findings from a meta-analysis show.

The results, published in the BMJ, indicate that the protective effect is particularly strong among patients who have previously suffered stroke and Asian patients, and support the continued use of ACE inhibitors in patients with only mild side effects who are at risk of pneumonia.

Overall, the use of ACE inhibitors reduced the risk of pneumonia by 34% compared with control treatment, and by 30% compared with ARBs. ARBs did not have a significant effect on pneumonia risk compared with control.

Pneumonia risk can be heightened by other conditions such as stroke. Following a stroke, 20% of patients will go on to contract pneumonia.

Here, subgroup analysis revealed that ACE inhibitors reduced pneumonia risk by 54% compared with control treatment in those who had previously had a stroke, and by 58% compared with ARBs.

Their effects were also particularly notable in Asian patients, in whom they were associated with a 57% reduction in risk of pneumonia. This compared with an 18% reduction in non-Asian patients.

The data were taken from 37 observational and interventional studies, and the authors call for more randomized trials to further clarify the associations.

Nevertheless, Dr Joao Costa (University of Lisbon, Portugal) and colleagues suggest their results could change prescribing habits: "These data may discourage the withdrawal of ACE inhibitors in some patients with tolerable adverse events (namely, cough) who are at particularly high risk of pneumonia."

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