• Joseph Fares, Omar El Fadel, Joy Zhao, Jianxin Sun, Jesse Roman, Giorgos Loizidis, and Ross Summer.
• Sidney Kimmel Medical College at Thomas Jefferson University; The Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University.
• Chest. 2024 Sep 21.

BackgroundSarcoidosis is a multisystem inflammatory disease where management and outcomes can vary widely. The renin-angiotensin-aldosterone system (RAAS) has been implicated in its pathogenesis, yet the impact of RAAS modulators on health outcomes in sarcoidosis remains poorly understood.Research QuestionHow do pharmacological modulators of RAAS affect health outcomes in patients diagnosed with sarcoidosis?Study Design And MethodsWe conducted a large multicenter investigation using the TriNetX Research Network database. Patients included in our study were individuals diagnosed with sarcoidosis and prescribed either an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB). All cohorts were matched for important covariates, and outcomes measured included mortality, cardiac and respiratory outcomes, and sepsis rates following sarcoidosis diagnosis.ResultsWe observed an increased mortality risk among sarcoidosis patients prescribed ACE inhibitors compared to patients prescribed ARB therapies. Furthermore, sarcoidosis patients prescribed ACE inhibitors had worse cardiac and respiratory outcomes, and increased sepsis rates compared to the ARB cohort.InterpretationOur findings suggest that ACE inhibitors and ARB's have divergent effects on outcomes in sarcoidosis patients. These findings highlight the potential pathogenic role of RAAS signaling in this disease and underscore the importance of carefully selecting RAAS modulators for individuals with sarcoidosis.Copyright © 2024. Published by Elsevier Inc.

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