What does this research mean for the field?

Black American users of ACE inhibitors have a substantially increased risk of angioedema compared with white subjects, independent of dose, specific ACE inhibitor, or concurrent medications. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

July 1, 1996

Black Americans have an increased rate of angiotensin converting enzyme inhibitor-associated angioedema*

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: ACE inhibitor use. Intervention: ACE inhibitors in black Americans vs. ACE inhibitors in white subjects. Primary outcome: Angioedema (RR 4.5, 95% CI 2.9 to 6.8).

Key Result

Black American users of ACE inhibitors had a substantially increased risk of angioedema compared with white subjects (RR 4.5; 95% CI 2.9 to 6.8).

Study Design

Type

Cohort

Structured PICO

Do Black Americans have an increased risk of ACE inhibitor-associated angioedema compared to White Americans?

Population

Participants in the Tennessee Medicaid Program (≥ 15 years of age) to whom ACE inhibitors had been prescribed from 1986 through 1992 (representing 51,752 person-years of use).

Intervention

ACE inhibitor use in Black Americans

Comparator

ACE inhibitor use in White Americans

Outcome

Confirmed angioedemasafety

Black Americans have a 4.5-fold increased risk of ACE inhibitor-associated angioedema compared to white patients, independent of dose or concurrent medications.

Main Result

Effect estimate: RR 4.5 (95% CI 2.9 to 6.8)

Abstract

OBJECTIVE: To study the association of race and other patient characteristics associated with angiotensin converting enzyme (ACE) inhibitor-associated angioedema. METHODS: This was a retrospective cohort study of participants in the Tennessee Medicaid Program ( >or= 15 years of age) to whom ACE inhibitors had been prescribed from 1986 through 1992. RESULTS: We identified 82 patients with confirmed angioedema during 51,752 person-years of ACE inhibitor use, giving an overall rate of angioedema of 1.6 per 1000 person-years of ACE inhibitor use. After potential confounding factors were controlled for, the adjusted relative risk (RR) of angioedema among black American users of ACE inhibitors was 4.5 (95% confidence interval CI 2.9 to 6.8) compared with white subjects. In addition to race, other factors associated with a significantly increased relative risk in the entire population were the first 30 days of ACE inhibitor use (RR, 4.6; 95% CI, 2.5 to 8.5) compared to > 1 year of use, use of either lisinopril (RR, 2.2; 95% CI, 1.2 to 3.9) or enalapril (RR, 2.2; 95% CI, 1.4 to 3.5) compared to captopril, and previous hospitalization for any diagnosis within 30 days (RR, 2.0; 95% CI, 1.1 to 3.6). Neither ACE inhibitor dose nor concurrent diuretic use was associated with the risk of angioedema. CONCLUSIONS: These data suggest that black Americans have a substantially increased risk of ACE inhibitor-associated angioedema compared with white subjects and that this increased risk cannot be attributed to an effect of dose, specific ACE inhibitor, or concurrent medications.

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Cite This Study

Brown et al. (Mon,) conducted a cohort in ACE inhibitor use. ACE inhibitors in black Americans vs. ACE inhibitors in white subjects was evaluated on Angioedema (RR 4.5, 95% CI 2.9 to 6.8). Black American users of ACE inhibitors had a substantially increased risk of angioedema compared with white subjects (RR 4.5; 95% CI 2.9 to 6.8).

synapsesocial.com/papers/6a16e065b13aec50ea6b9802 https://doi.org/https://doi.org/10.1016/s0009-9236(96)90161-7

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