(83) Angiotensin Converting Enzyme Inhibitors-Related Adverse Drug Reactions and The Risk of Subsequent Cardiovascular Events and All-Cause Mortality: A Retrospective Cohort Study in The United Kingdom

Sunday, August 28, 2022

8:00 AM – 1:45 PM CEST

Location: Hall C

Publication Number: 1128

Presenting Author(s)

Widya Norma Insani, MSc
– PhD Student, Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom., London, United Kingdom

Co-Author(s)

Cate Whittlesea
– Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom, United Kingdom
Chengsheng Ju, MPharm
– UCL School of Pharmacy, London, United Kingdom
Kenneth Man, PhD
– Lecturer in Pharmacoepidemiology and Medication Safety, University of Hong Kong, London, United Kingdom
Hassan Hasan Alwafi, doctoral in Pharmacoepidemiology
– Assistant Professor, Umm Al-Qura University, Makkah, Saudi Arabia
Matthew Adesuyan, MPharm
– Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom., University College London, London, United Kingdom
Sarah Chapman
– Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom, United Kingdom
Li Wei
– Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom, United Kingdom

Background: Angiotensin converting enzyme inhibitors (ACEIs) are medicines used to treat hypertension, heart failure, and renal diseases. Patients with ACEIs-related adverse drug reaction (ADR) often have their treatment interrupted and their medication adherence impaired. These patients might be at the increased risk of subsequent cardiovascular disease (CVD) event and all-cause mortality.

Objectives: To investigate the risk of subsequent CVD events and all-cause mortality in patients with ACEIs-related ADR consultations in primary care and examine treatment pattern changes following the ACEIs-related ADR .

Methods: This was a retrospective cohort study among ACEIs users between 2004-2019 using the IQVIA Medical Research Data. Patients with ACEIs-related ADR consultation in primary care (exposure group) were matched (1:1) using propensity scores to ACEIs users without ADR consultations (comparator group) based on demographics, comorbidities, and concomitant medication. Cox proportional hazard regression model was used to compare the risk of CVD events and all-cause mortality, stratified by history of CVD. Treatment pattern changes within one year period following the ACEI-related ADR were subsequently examined.

Results: Among 1,284,819 ACEIs users, 9,144 (0.71%) had an ACEIs-related ADR consultation in primary care. The mean (SD) follow-up time was 6.62±3.91 and 5.94±3.81 years for the primary and secondary prevention cohorts, respectively. ACEIs-related ADR was associated with subsequent CVD event in both cohorts (adjusted hazard ratio (aHR) of 1.21 (1.02, 1.44) and 1.22 (1.11, 1.33), respectively), but not all-cause mortality. About a third of the patients (34.7%) switched to angiotensin receptor blockers (ARBs), 12.4% continued the use of ACEIs, 44.9% used other anti-hypertensive drugs, and 8.1% discontinued all antihypertensive drugs.

Conclusions: Patients with ACEIs-related ADR had an increased risk of subsequent CVD events, implying that closer monitoring of the affected patients should be conducted to avert the risk. Further research should examine appropriate intervention strategies following the ADR to reduce the burden of ADR for patients and healthcare service.