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Research paper
Preadmission use of ACE inhibitors or angiotensin receptor blockers and short-term mortality after stroke
  1. J Sundbøll1,2,
  2. M Schmidt1,2,
  3. E Horváth-Puhó1,
  4. CF Christiansen1,
  5. L Pedersen1,
  6. HE Bøtker2,
  7. HT Sørensen1
  1. 1Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
  2. 2Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
  1. Correspondence to Dr Jens Sundbøll, Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N DK-8200, Denmark; jens.sundboll{at}dce.au.dk

Abstract

Background and aim The prognostic impact of ACE inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) on stroke mortality remains unclear. We aimed to examine whether prestroke use of ACE-Is or ARBs was associated with improved short-term mortality following ischaemic stroke, intracerebral haemorrhage (ICH) and subarachnoid haemorrhage (SAH).

Methods We conducted a nationwide population-based cohort study using medical registries in Denmark. We identified all first-time stroke patients during 2004–2012 and their comorbidities. We defined ACE-I/ARB use as current use (last prescription redemption <90 days before admission for stroke), former use and non-use. Current use was further classified as new or long-term use. We used Cox regression modelling to compute 30-day mortality rate ratios (MRRs) with 95% CIs, controlling for potential confounders.

Results We identified 100 043 patients with a first-time stroke. Of these, 83 736 patients had ischaemic stroke, 11 779 had ICH, and 4528 had SAH. For ischaemic stroke, the adjusted 30-day MRR was reduced in current users compared with non-users (0.85, 95% CI 0.81 to 0.89). There was no reduction in the adjusted 30-day MRR for ICH (0.95, 95% CI 0.87 to 1.03) or SAH (1.01, 95% CI 0.84 to 1.21), comparing current users with non-users. No association with mortality was found among former users compared with non-users. No notable modification of the association was observed within sex or age strata.

Conclusions Current use of ACE-Is/ARBs was associated with reduced 30-day mortality among patients with ischaemic stroke. We found no association among patients with ICH or SAH.

  • STROKE
  • CEREBROVASCULAR DISEASE
  • SUBARACHNOID HAEMORRHAGE

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