Current prestroke use of ACE inhibitors or ARBs was associated with reduced 30-day mortality among patients with ischaemic stroke (MRR 0.85; 95% CI 0.81-0.89), but not in those with ICH or SAH.
Cohort (n=100,043)
Yes
Does preadmission use of ACE inhibitors or ARBs reduce 30-day mortality in patients with first-time stroke?
Preadmission use of ACE inhibitors or ARBs is associated with a 15% reduction in 30-day mortality following ischaemic stroke, but not following hemorrhagic stroke.
Effect estimate: MRR 0.85 (95% CI 0.81 to 0.89)
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.
Sundbøll et al. (Wed,) conducted a cohort in First-time stroke (ischaemic, intracerebral haemorrhage, subarachnoid haemorrhage) (n=100,043). ACE inhibitors or angiotensin receptor blockers (current use) vs. Non-use was evaluated on 30-day mortality for ischaemic stroke (MRR 0.85, 95% CI 0.81 to 0.89). Current prestroke use of ACE inhibitors or ARBs was associated with reduced 30-day mortality among patients with ischaemic stroke (MRR 0.85; 95% CI 0.81-0.89), but not in those with ICH or SAH.
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