Continued use of ACE inhibitors after a first angioedema episode was associated with a higher recurrence rate compared to discontinuation (18.7 vs 1.8 per 100 patient-years; P=.001).
Cohort (n=82)
Does continued use of ACE inhibitors increase the risk of recurrent angioedema in patients with a prior episode?
Continuing ACE inhibitors after an initial episode of angioedema significantly increases the risk of recurrence, highlighting the need for prompt recognition and discontinuation.
Absolute Event Rate: 18.7% vs 1.8%
p-value: p=.001
CONTEXT: Angiotensin-converting enzyme (ACE) inhibitors are associated with an increased risk of angioedema, but the risk of recurrent angioedema if treatment is continued is not known. OBJECTIVE: To test the hypothesis that the association between ACE inhibitor use and angioedema may not be recognized and to determine characteristics of angioedema associated with continued use of ACE inhibitors. DESIGN: Retrospective cohort study. SETTING: Tennessee Medicaid program. PATIENTS: Medicaid enrollees aged 15 years or older who used an ACE inhibitor and had a first documented episode of angioedema between 1986 and 1992 were followed up for recurrent episodes through June 1993. MEASUREMENTS AND MAIN RESULTS: We previously identified 82 patients with a first confirmed diagnosis of angioedema during 51 752 person-years of ACE inhibitor use in this population (1.6 per 1000 person-years). Among these 82 patients, there were 16 outpatient recurrences of angioedema among 13 patients during 189 patient-years of follow-up (8.5 per 100 patient-years). The rate of angioedema was much higher in users of ACE inhibitors with continued exposure (18.7 per 100 patient-years) than in those whose use of the drug was discontinued (1.8 per 100 patient-years) (P=.001). Review of the medical records for patients taking ACE inhibitors who had recurrent angioedema revealed that physicians attributed angioedema to a number of causes not related to ACE inhibitor use, even after multiple recurrences. CONCLUSION: Continuing use of ACE inhibitors in spite of angioedema results in a markedly increased rate of angioedema recurrence with serious morbidity.
Nancy J. Brown (Wed,) conducted a cohort in ACE inhibitor-associated angioedema (n=82). Continued use of ACE inhibitors vs. Discontinued use of ACE inhibitors was evaluated on recurrent episodes of angioedema (p=.001). Continued use of ACE inhibitors after a first angioedema episode was associated with a higher recurrence rate compared to discontinuation (18.7 vs 1.8 per 100 patient-years; P=.001).