Effectiveness of angiotensin‐converting enzyme inhibitors and angiotensin receptor blockers on total and cardiovascular mortality and morbidity in primary prevention: A nationwide study based on French Health Insurance Data (SNDS)

• DOI: 10.1111/jch.14445
• Publication Date: 2022-03-01T09:46:08Z
• Authors: Emmanuel Oger; Sandrine Kerbrat; Emmanuel Nowak; François Paillard; Pierre‐Yves Scarabin; André Happe
• Keywords: Angiotensin Receptor Blockers

Abstract Angiotensin‐converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) both inhibit the renin‐angiotensin system (RAS) but have different sites of action. Whether clinically meaningful differences exist is still debated. The authors set up a population‐based nationwide retrospective cohort study with at least 5 years follow‐up based on comprehensive French Health Insurance Database linked to hospital discharge database. Patients aged 50 or above, identified as ARB ACE inhibitor new users in 2009 (at one delivery during year no such 2008) were eligible. Exclusion criteria included history cancer, cardiovascular disease, chronic renal insufficiency. Main outcome measure was overall mortality. Secondary outcomes deaths, major events, other events. Out 407 815 eligible patients, 233 682 (57%) users; two‐third had previous exposure antihypertensive drug. Based propensity‐score Cox model, user group better (HR: .878, 95%CI, .854 .902), .841, .800 .84) survival lower risk for events .886, .868 .905). Statistically significant quantitative interactions detected diabetes. Considering subgroup analyses, ARBs than nondiabetic patients.