Antihypertensive Medications and Pneumonia: A Positive Benefit?

Repurposing approved drugs—also known as drug repositioning—is a process of identifying new therapeutic use(s) for old, existing, and available drugs. It is an effective strategy in discovering or developing drug molecules with new pharmacological and therapeutic indications. To this point, angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) have been shown to lower mortality risk in patients hospitalized with influenza or pneumonia.^1-3 

Adult patients’ medical records who were hospitalized with influenza or pneumonia from 2005-2018 in Denmark were retrospectively reviewed.⁴ Thirty-day mortality and risk of admission to an intensive care unit in ACEi/ARBs users were compared with nonusers and a control group of calcium channel blockers.  Using propensity score matching, ACEi/ARBs had a 13.9% versus 14.5% lower 30-day mortality versus non-users (Relative Risk [RR]: 0.96; 95% CI: 0.93-0.99) and a lower risk of admission to the intensive care unit of (RR) 0.83; 95% CI:0.80-0.87). 

We conducted a smaller study using a medical claims de-identified database in patients 65 years and older with pneumonia hospitalizations without neurological disorders affective swallowing.⁵ The association between ACEi use and pneumonia hospitalization and mortality were determined using logistic regression was determined. The population mean age was 73.7±7.3 (range 65-114 [56.5% female]) years with 58% between 65-74 years, 32% 75-84, and 10% over the age of 85 years. Chronic ACEi use reduced pneumonia hospitalization by HR 0.88; (95% CI: 0.85-0.92).

These studies show that in older patients at risk of pneumonia, likely without neurological disorders affective swallowing, ACEi or ARBs may be considered as a preventative measure against hospitalization, intensive care admission, and potentially mortality.

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References

1. Caldeira D, Alarcao J, Vaz-Carneiro A, Costa J.  Risk of pneumonia associated with the use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers: systematic review and meta-analysis. BMJ 2012;345:34260.
2. Mortensen EM, Nakashima B, Cornell J, et al. Population-based study of statins, angiotensin II receptor blockers, and angiotensin-converting enzyme inhibitors on penumonia-related outcomes. Clin Infect Dis 2012;55:1466-73.
3. Wu A, Good C, Downs JR, Fine MJ, Pugh MJ,Anzueto A, Mortensen EM. The association of cardioprotective medications with pneumonia-related outcomes. PloS One 2014;9:e85797.
4. Christiansen CF, Heide-Jøgensen U, Rasmussen TB, et al. Renin-angiotensin system blockers and adverse outcomes of influenza and pneumonia: A Danish Cohort Study. JAHA 2020;9:e017297. Doi: 10.1161/JAHA.120.017297.
5. Alexander DP, Nickman NA, Oderda GM, Stoddard GJ, Munger MA. Angiotensin converting enzyme inhibitors (ACEI) reduce pneumonia risk.  Pharmacother 2006;26(10):143