Antihypertensive agents acting on the renin-angiotensin system and the risk of sepsis

作者：Dial Sandra; Nessim Sharon J; Kezouh Abbas; Benisty Jacques; Suissa Samy^*

来源：British Journal of Clinical Pharmacology, 2014, 78(5): 1151-1158.

DOI：10.1111/bcp.12419

• angiotensin-converting enzyme inhibitor
• angiotensin receptor blocker
• hypertension
• renal failure
• sepsis
• telmisartan

AimsIn response to safety concerns from two large randomized controlled trials, we investigated whether the use of telmisartan, an angiotensin receptor blocker (ARB), ARBs as a class and angiotensin-converting enzyme inhibitors (ACEIs) increase the risk of sepsis, sepsis-associated mortality and renal failure in hypertensive patients.
MethodsWe performed a nested case-control study from a retrospective cohort of adults with hypertension from the UK General Practice Research Database diagnosed between 1 January 2000 and 30 June 2009. All subjects hospitalized with sepsis during follow-up were matched for age, sex, practice and duration of follow-up with 10 control subjects. Exposure was defined as current use of antihypertensive drugs.
ResultsFrom the cohort of 550436 hypertensive patients, 1965 were hospitalized with sepsis during follow-up (rate 6.9 per 10000 per year), of whom 824 died and 346 developed acute renal failure within 30 days. Compared with use of -blockers, calcium-channel blockers or diuretics, use of ARBs, including telmisartan, was not associated with an elevated risk of sepsis (relative risk 1.09; 95% confidence interval 0.83-1.43); but use ACEIs was (relative risk 1.65; 95% confidence interval 1.42-1.93). Users of ARBs, -blockers, calcium-channel blockers or diuretics, but not users of ACEIs, had lower rates of hospitalization for sepsis compared with untreated hypertensive patients. Findings were similar for sepsis-related 30 day mortality and renal failure.
ConclusionsHypertensive patients treated with ARBs, including telmisartan, do not appear to be at increased risk of sepsis or sepsis-related 30 day mortality or renal failure. On the contrary, users of ACEIs may have an increased risk.

• 出版日期2014-11
• 单位McGill