• Chih-Cheng Lai, Ya-Hui Wang, Cheng-Yi Wang, Hao-Chien Wang, Chong-Jen Yu, and Likwang Chen.
• Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Taiwan.
• Int J Chron Obstruct Pulmon Dis. 2018 Jan 1; 13: 867-874.

ObjectivesThis study aimed to compare the effects of angiotensin-converting-enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) on the risk of pneumonia and severe exacerbations in patients with COPD.Patients And MethodsAll patients with COPD who used ACEis and ARBs for >90 days between 2000 and 2005 were recruited. Pairwise matching (1:1) of the ACEi and ARB groups resulted in two similar subgroups, with 6,226 patients in each. The primary outcomes were pneumonia and COPD exacerbations, and the secondary outcome was death.ResultsDuring the follow-up period, the incidence of pneumonia was 7.20 per 100 person-years in the ACEi group and 5.89 per 100 person-years in the ARB group. The ACEi group had a higher risk of pneumonia (adjusted hazard ratio [aHR], 1.22; 95% CI, 1.15-1.29) than the ARB group. The incidence of severe exacerbations was 0.65 per person-year for the patients receiving ACEis and 0.52 per person-year for those receiving ARBs. The patients receiving ACEis had a higher risk of severe exacerbations (aHR, 1.19; 95% CI, 1.16-1.21) than those receiving ARBs. Similar trends were noted in terms of severe exacerbations requiring hospitalization (aHR, 1.24; 95% CI, 1.21-1.28) or emergency department visits (aHR, 1.16; 95% CI, 1.13-1.18), pneumonia requiring mechanical ventilation (aHR, 1.35; 95% CI, 1.24-1.47), and mortality (aHR, 1.33; 95% CI, 1.26-1.42).ConclusionARBs were associated with lower rates of pneumonia, severe pneumonia, and mortality than ACEis in patients with COPD.

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