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Challenges in Comparing Effectiveness of Angiotensin Receptor Blockers vs. Angiotensin-Converting Enzyme Inhibitors for Hypertension in Medicare Data

An evidence gap exists in comparing the effectiveness of angiotensin receptor II blockers (ARBs) vs. angiotensin-converting enzyme inhibitors (ACEIs). We identified elderly hypertensive patients who initiated ACEI/ARBs after a hospitalization for coronary artery disease, heart failure, or stroke eli...

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Autores principales: Setoguchi, Soko, Shrank, William H, Liu, Jun, Lee, Jennifer C, Saya, Uzaib, Winkelmayer, Wolfgang C., Dreyer, Nancy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8596380/
https://www.ncbi.nlm.nih.gov/pubmed/21451506
http://dx.doi.org/10.1038/clpt.2011.17
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author Setoguchi, Soko
Shrank, William H
Liu, Jun
Lee, Jennifer C
Saya, Uzaib
Winkelmayer, Wolfgang C.
Dreyer, Nancy
author_facet Setoguchi, Soko
Shrank, William H
Liu, Jun
Lee, Jennifer C
Saya, Uzaib
Winkelmayer, Wolfgang C.
Dreyer, Nancy
author_sort Setoguchi, Soko
collection PubMed
description An evidence gap exists in comparing the effectiveness of angiotensin receptor II blockers (ARBs) vs. angiotensin-converting enzyme inhibitors (ACEIs). We identified elderly hypertensive patients who initiated ACEI/ARBs after a hospitalization for coronary artery disease, heart failure, or stroke eligible for Medicare and state pharmacy assistance programs. Among 18,801 initiators of ACEIs and 2,641 initiators of ARBs, 2,535 deaths were identified. We observed substantial differences in characteristics between ARB and ACEI initiators, suggesting that ARB users were more health-seeking. The incidence of death and sudden cardiac death (SCD) in ACEI initiators was 77 and 22 per 1000 person-years, respectively. The relative risk for SCD was 0.69 (95% CI 0.50–0.96) in ARB initiators, which was 1.1 after restricting to low ejection fraction (EF) patients. The reduced risk of SCD is explained, at least partly, by 1) residual confounding by ARB users being healthier on unobserved domains and 2) lack of data on EF.
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spelling pubmed-85963802021-11-17 Challenges in Comparing Effectiveness of Angiotensin Receptor Blockers vs. Angiotensin-Converting Enzyme Inhibitors for Hypertension in Medicare Data Setoguchi, Soko Shrank, William H Liu, Jun Lee, Jennifer C Saya, Uzaib Winkelmayer, Wolfgang C. Dreyer, Nancy Clin Pharmacol Ther Article An evidence gap exists in comparing the effectiveness of angiotensin receptor II blockers (ARBs) vs. angiotensin-converting enzyme inhibitors (ACEIs). We identified elderly hypertensive patients who initiated ACEI/ARBs after a hospitalization for coronary artery disease, heart failure, or stroke eligible for Medicare and state pharmacy assistance programs. Among 18,801 initiators of ACEIs and 2,641 initiators of ARBs, 2,535 deaths were identified. We observed substantial differences in characteristics between ARB and ACEI initiators, suggesting that ARB users were more health-seeking. The incidence of death and sudden cardiac death (SCD) in ACEI initiators was 77 and 22 per 1000 person-years, respectively. The relative risk for SCD was 0.69 (95% CI 0.50–0.96) in ARB initiators, which was 1.1 after restricting to low ejection fraction (EF) patients. The reduced risk of SCD is explained, at least partly, by 1) residual confounding by ARB users being healthier on unobserved domains and 2) lack of data on EF. 2011-03-30 2011-05 /pmc/articles/PMC8596380/ /pubmed/21451506 http://dx.doi.org/10.1038/clpt.2011.17 Text en Users may view, print, copy, download and text and data- mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use: http://www.nature.com/authors/editorial_policies/license.html#terms
spellingShingle Article
Setoguchi, Soko
Shrank, William H
Liu, Jun
Lee, Jennifer C
Saya, Uzaib
Winkelmayer, Wolfgang C.
Dreyer, Nancy
Challenges in Comparing Effectiveness of Angiotensin Receptor Blockers vs. Angiotensin-Converting Enzyme Inhibitors for Hypertension in Medicare Data
title Challenges in Comparing Effectiveness of Angiotensin Receptor Blockers vs. Angiotensin-Converting Enzyme Inhibitors for Hypertension in Medicare Data
title_full Challenges in Comparing Effectiveness of Angiotensin Receptor Blockers vs. Angiotensin-Converting Enzyme Inhibitors for Hypertension in Medicare Data
title_fullStr Challenges in Comparing Effectiveness of Angiotensin Receptor Blockers vs. Angiotensin-Converting Enzyme Inhibitors for Hypertension in Medicare Data
title_full_unstemmed Challenges in Comparing Effectiveness of Angiotensin Receptor Blockers vs. Angiotensin-Converting Enzyme Inhibitors for Hypertension in Medicare Data
title_short Challenges in Comparing Effectiveness of Angiotensin Receptor Blockers vs. Angiotensin-Converting Enzyme Inhibitors for Hypertension in Medicare Data
title_sort challenges in comparing effectiveness of angiotensin receptor blockers vs. angiotensin-converting enzyme inhibitors for hypertension in medicare data
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8596380/
https://www.ncbi.nlm.nih.gov/pubmed/21451506
http://dx.doi.org/10.1038/clpt.2011.17
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