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Angiotensin Receptor Blockers and Angiotensin‐Converting Enzyme Inhibitors: Challenges in Comparative Effectiveness Using Medicare Data
Author(s) -
Setoguchi S,
Shrank WH,
Liu J,
Lee JC,
Saya U,
Winkelmayer WC,
Dreyer NA
Publication year - 2011
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1038/clpt.2011.17
Subject(s) - medicine , heart failure , ejection fraction , confounding , residual risk , angiotensin receptor blockers , cardiology , coronary artery disease , angiotensin converting enzyme , relative risk , sudden cardiac death , confidence interval , stroke (engine) , angiotensin receptor , angiotensin ii , receptor , blood pressure , mechanical engineering , engineering
An evidence gap exists in comparing the effectiveness of angiotensin receptor II blockers (ARBs) for hypertension with that of angiotensin‐converting enzyme inhibitors (ACEIs). We identified elderly hypertensive patients in whom ACEI/ARB therapy had been initiated after hospitalization for coronary artery disease (CAD), heart failure (HF), or stroke and who were eligible for Medicare and state pharmacy assistance programs. Of 18,801 initiators of ACEIs and 2,641 initiators of ARBs, 2,535 died during the follow‐up. We observed substantial differences in characteristics between ARB and ACEI initiators, suggesting that ARB users were more health seeking. The incidence of death and sudden cardiac death (SCD) in ACEI initiators was 77 and 22 per 1,000 person‐years, respectively. The relative risk for SCD comparing ARB initiators to ACEI initiators was 0.69 (95% confidence interval (CI) 0.50–0.96); when the analysis was restricted to patients with low ejection fraction (EF), the relative risk was 1.1. The reduced risk of SCD can be explained, at least partly, by (i) residual confounding because ARB users were healthier on unobserved domains and (ii) lack of data on EF. Clinical Pharmacology & Therapeutics (2011) 89 5, 674–682. doi: 10.1038/clpt.2011.17