• Shu-Chen Chien, Shuo-Ming Ou, Chia-Jen Shih, Pei-Wen Chao, Szu-Yuan Li, Yi-Jung Lee, Shu-Chen Kuo, Shuu-Jiun Wang, Tzeng-Ji Chen, Der-Cherng Tarng, Hsi Chu, and Yung-Tai Chen.
• From the School of Pharmacy, College of Pharmacy, Taipei Medical University (S-CC), Department of Pharmacy, Taipei Medical University Hospital (S-CC), Clinical Research Center, Taipei Medical University Hospital (S-CC), School of Medicine, National Yang-Ming University (S-MO, C-JS, S-YL, Y-JL, S-CK, S-JW, D-CT, Y-TC), Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital (S-MO, S-YL, D-CT), Institute of Clinical Medicine, National Yang-Ming University, Taipei (S-MO, D-CT), Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan (C-JS), School of Medicine, Taipei Medical University (P-WC), Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University (P-WC), Department of Neurology, Taipei City Hospital, Ren Ai Branch, Taipei (Y-JL), National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County (S-CK), Division of Infectious Diseases, Taipei Veterans General Hospital (S-CK), Institute of Brain Science, National Yang-Ming University (S-JW), Department of Neurology, Neurological Institute, Taipei Veterans General Hospital (S-JW), Department of Family Medicine, Taipei Veterans General Hospital (T-JC), Department and Institute of Physiology, National Yang-Ming University (D-CT), Department of Chest, Taipei City Hospital, Heping Fuyou Branch (HC); and Division of Nephrology, Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan (Y-TC).
• Medicine (Baltimore). 2015 Oct 1; 94 (43): e1751.

AbstractRenin and aldosterone activity levels are low in elderly patients, raising concerns about the benefits and risks of angiotensin-converting-enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARB) use. However, data from direct comparisons of the effects of ACEIs on ARBs in the elderly population remain inconclusive.In this nationwide study, all patients aged ≥ 70 years were retrieved from the Taiwan National Health Insurance database for the period 2000 to 2009 and were followed up until the end of 2010. The ARB cohort (12,347 patients who continuously used ARBs for ≥ 90 days) was matched to ACEI cohort using high-dimensional propensity score (hdPS). Intention-to-treat (ITT) and as-treated (AT) analyses were conducted.In the ITT analysis, after considering death as a competing risk, the ACEI cohort had similar risks of myocardial infarction (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.79-1.06), ischemic stroke (HR 0.98, 95% CI 0.90-1.07), and heart failure (HR 0.93, 95% CI 0.83-1.04) compared with the ARB cohort. No difference in adverse effects, such as acute kidney injury (HR 0.99, 95% CI 0.89-1.09) and hyperkalemia (HR 1.02, 95% CI 0.87-1.20), was observed between cohorts. AT analysis produced similar results to those of ITT analysis. We were unable to demonstrate a survival difference between cohorts (HR 1.03, 95% CI 0.88-1.21) after considering drug discontinuation as a competing risk in AT analysis.Our study supports the notion that ACEI and ARB users have similar risks of major adverse cardiovascular events (MACE), even in elderly populations.

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