A Study on Utilization of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients with Cardiovascular Diseases (original) (raw)
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Malaysian family physician : the official journal of the Academy of Family Physicians of Malaysia, 2022
Introduction: The incidence of angiotensin-converting enzyme inhibitors (ACEi)-induced cough has been reported between 5% and 30% but is unknown in Malaysia. This study aimed to determine the incidence of ACEi-induced cough and its associated factors in a public primary care clinic in Malaysia. Methods: A retrospective review of electronic medical records of patients who were initiated ACEi between January 1, 2015, and December 31, 2015, and reviewed until July 31, 2016. A total of 1,091 patients were newly prescribed ACEi, and 394 patients were eligible for this study. We excluded patients who defaulted follow-ups with no further clinic visits before July 31, 2016, were transferred to the clinic without the recorded date of ACEi initiation, were transferred to other clinics during the study period, were followed up at other clinics and attended the study clinic for a short period, or were given only a stat dose of ACEi. Results: Among the 394 patients initiated on ACEi, 225 (57.1%) were male, 369 (93.7%) were Malay, 376 (95.4%) had hypertension, and 192 (48.7%) had diabetes. The incidence of ACEiinduced cough was 24.1%, and 42 (10.7%) patients developed cough on the day of therapy initiation. There was no association between age, gender, ethnicity, type of ACEi, and cough. Conclusion: Approximately one quarter of patients developed cough after ACEi initiation, and approximately half of them developed cough within 1 week of ACEi initiation. Doctors should consider early follow-up for patients initiated on ACEi therapy to ensure adherence, quality of life, and minimise unnecessary treatment.
Singapore Medical Journal, 2014
RESUlTS A total of 424 patients were identified during the study period. Out of the 424 patients, 129 (30.4%) discontinued the use of ACE inhibitors due to cough. Overall, 90 (21.2%) patients who were initially started on ACE inhibitors were eventually switched to angiotensin receptor blockers (ARBs). CONClUSION In our cohort, the incidence of discontinuation of ACE inhibitors due to cough is higher than most other studies. The relationship between ethnicity and tolerance of medications should not be underestimated. As there is a high incidence of discontinuation of ACE inhibitors due to cough in the local population, ARBs may be a reasonable substitute as a first-line medication, if clinically indicated.
International Journal of Pharmacy and Pharmaceutical Sciences, 2020
Objective: To evaluate the drug utilization of Angiotensin Receptor Blocker (ARB) along with their ADRs in a tertiary care hospital. And to monitor, report of adverse drug reaction and drug interactions, if any. Methods: The patients who meet the inclusion and exclusion criteria were enrolled into the study. The pertinent data such as demographic details, drug name, dose, frequency, and laboratory data were gathered from medical records of the patient and results were analyzed. Results: Total of 100 patients were included in this study, the maximum utilization of antihypertensive drug (ARB) was telmisartan (90%) and widely use of ARBs in the age group of 41-50 y. Total 32 ADRs were observed and most probable ADRs included headache (42.8%), Nausea (14.28%) and dizziness (12.5%). Conclusion: Telmisartan was the most prescribed and utilized drug than the other drugs of ARBs. Maximum ADRs were noted in females, the most frequent ADRs headache, nausea and dizziness were reported. The maj...
Are Physicians Aware of the Side Effects of Angiotensin-Converting Enzyme Inhibitors?
Chest, 2005
Angiotensin-converting enzyme inhibitors (ACE-I) are considered safe, but they are associated with characteristic side effects, namely cough and angioedema, usually requiring discontinuation. We perceived that referrals for these side effects have become more and more frequent; therefore, we evaluated the degree of knowledge on the safety of ACE-I in different medical categories. Design: A questionnaire (13 questions) on side effects of ACE-I was posted to physicians. Setting: Everyday clinical practice. Participants: Cardiologists, allergists, and general practitioners (GPs) from the National Healthcare System. Measurement and results: Three hundred twelve physicians were contacted, and 154 returned questionnaires that could be analyzed. Of the 154 physicians (mean age, 45 years) 48 were cardiologists, 52 were GPs, and 54 were allergists. The percentage of correct answers was low: 31.9% for cardiologists, 40% for GPs, and 33% for allergists. Thus, GPs provided a significantly higher percentage of correct answers with respect to the remaining categories (p ؍ 0.05). The lower rate of correct answers (0 to 15.9%) concerned the time of onset of cough and the action to take. Cardiologists seemed to be less aware of the fact that angiotensin receptor blockers (sartans) can cross-react with ACE-I. Conclusion: Overall, there was a poor knowledge of the side effects of ACE-I. This may account for the increased referrals for chronic cough and angioedema.
European journal of clinical pharmacology, 2001
, the Italian Ministry of Health limited angiotensin-II type-1 (AT 1 ) receptor antagonist reimbursement only to patients who necessitated discontinuation of angiotensin converting enzyme (ACE) inhibitor treatment due to cough or angioedema. We assessed the consequences of this decision on the reporting of ACE inhibitor-associated adverse drug reactions (ADRs). Methods: ACE inhibitor-associated ADRs reported to the national pharmacovigilance system in 1997±2000 in the district of Varese (northern Italy, more than 820,000 inhabitants) were retrieved and analysed. The dispensation of ACE inhibitors and AT 1 receptor antagonists reimbursed by the National Health System was also examined. Results: There were 228 reports of ACE inhibitor-associated ADRs, and cough was the ADR reported in 93.4% of cases. There were no reports
Cough due to ace inhibitors: a case-control study using automated general practice data
European Journal of Clinical Pharmacology, 1996
Objectives: To determine the risk of coughing as an adverse reaction to ACE inhibitors under everyday circumstances in a large population, and to study whether this adverse effect was duration or dose dependent. Design: A population-based case-control study. Setting: Ten general practices of 14 Dutch general practitioners (GP), in which all consultations, morbidity and medical interventions, including drugs prescribed, were registered over the 18 month period from 1st September, 1992 to 1st March, 1994. Subjects: 1458 patients with incident coughing and up to four controls per case were obtained (total 4182 controls), matched for GR All cases and controls were 20 years or older and had no record of respiratory infection, influenza, tuberculosis, asthma, chronic bronchitis, emphysema, congestive heart failure, sinusitis, laryngitis, haemoptysis or respiratory neoplasms during the study period. Results: Cases were 2.1-times more likely than controls to have been exposed to ACE inhibitors (95% CI 1.5-3.1), but after adjustment the odds ratio was 1.4 (95% CI 0.9-2.1). The crude odds ratio for captopril was 1.3 (95% CI 0.7-2.5), for enalapril 2.6 (95% CI 1.6-4.2) and for lisinopril 2.0 (95% CI 0.5-9.3). The adjusted odds ratio for captopril was 0.9 (95% CI 0.4 1.7), for enalapril 1.7 (95% CI 1.03-2.8) and for lisinopril 1.7 (95% CI 0.4-7.9). For patients who had been on ACE inhibitor treatment for no longer than 2
Journal of Human Hypertension, 2002
Since coronary artery and cerebrovascular diseases are the most common serious complications of long standing hypertension, there is a great potential for combining treatment with aspirin and angiotensin-converting enzyme inhibitors (ACE-I). However, the data regarding interaction of aspirin and ACE-I in relation to blood pressure control and survival benefits are controversial and inconclusive. We presumed that the appearance of dry cough in some of the patients following initiation of ACE-I treatment could be used as a marker for the presence of their influence, whereas ACE-I cough attenuation after addition of aspirin to treatment could be a sign of aspirin and ACE-I interaction on clinical level. The present study was aimed to use ACE-I induced cough as a clinical marker of ACE-I activity to determine whether dose-dependent aspirin and ACE-I interaction does exist. In a cohort of 750 consecutive ACE-I treated hypertensive and postinfarction outpatients we identified 78 (10.4%) non-smoking ACE-I related coughers. Out of them, 31 (21 men, 10 women; mean age 61 ± 0.9 years) agreed to take part in the study, which was aimed to compare two regimens of combined ACE-I and aspirin treatment (self-matched control data): intermediate (500 mg daily) vs low-dose aspirin (100 mg daily). On each visit the life quality, cough severity (CS, 0-4) and frequency (CF, 0-10) scores were registered. Low doses