ANGIOTENSIN‐CONVERTING ENZYME INHIBITORS AND PNEUMONIA IN ELDERLY PATIENTS WITH INTRACEREBRAL HEMORRHAGE

Abstract

To the Editor: Angiotensin-converting enzyme (ACE) inhibitors have been shown to have beneficial effects, such as antihypertension, vasodilation in congestive heart failure, and renoprotection.1 It is also reported that ACE inhibitors improve silent aspiration2 and prevent pneumonia in elderly patients with cerebral infarction.3–6 However, little is known about whether ACE inhibitors have a beneficial role in reducing the risk of pneumonia in elderly patients with hemorrhagic brain injury. Therefore, the effects of ACE inhibitors on the incidence of pneumonia in the elderly patients with intracerebral hemorrhage were investigated. Eighty-three patients (40 men, 43 women, mean age±standard error=68±2) hospitalized for intracerebral hemorrhage were enrolled and prospectively followed for 2 years. The criteria for diagnosis of pneumonia, as well as the patients' inclusion and exclusion criteria, were described previously.7 The eligible patients were those who suffered from intracerebral hemorrhage but were not bedridden. Incidence of pneumonia was analyzed in two groups: patients who received ACE inhibitors and patients who did not receive any antihypertensive drugs. Twenty-two hypertensive patients (9 men, 13 women; mean age 72±2) received ACE inhibitors after admission. The control group consisted of 61 patients (31 men, 30 women; mean age 66±2) without hypertension. For the main analysis, the log-rank procedure and Cox proportional hazards model were used to calculate confidence intervals. The cumulative incidence curves were generated using the Kaplan-Meier method for endpoints in the ACE inhibitor and control groups. Significance was set at P<.05. There were no significant differences in age, sex, or stroke severity between the two groups. During the follow-up, new pneumonia was diagnosis in two (9.1%) of 22 patients in the ACE inhibitor group and 13 (21.3%) of 61 patients in the control group. The patients in the ACE inhibitor group had a lower risk of pneumonia than those in the control group (hazard ratio=0.19 (95% confidence interval=0.04–0.86, P=.03). These findings suggest that ACE inhibitors have a beneficial role in reducing the risk of pneumonia in elderly patients with intracerebral hemorrhage as well as in elderly patients with cerebral infarction. Therefore, ACE inhibitors may be useful for preventing aspiration pneumonia in elderly stroke patients. Financial Disclosure(s): Drs. Jun Harada and Kiyohisa Sekizawa do not have a financial relationship with any commercial entity that may have an interest in the subject of this manuscript. Author Contributions: Jun Harada: study design, acquisition of subject, data analysis, preparation of manuscript. Kiyohisa Sekizawa: study concept, interpretation of data, preparation of manuscript. Sponsor's Role: None.