Effect of angiotensin 2 receptor blockers on chronic obstructive lung disease mortality: A retrospective cohort study

Paulin, Pilar; Furcada, Joaquín Maritano; Ungaro, C.; Bendelman, Gisela; Waisman, Gabriel; Castro, Horacio Matías; Giunta, Diego; Ferreyro, Bruno L.

doi:10.1016/j.pupt.2017.03.007

Cited by 11 publications

(10 citation statements)

References 18 publications

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“…Current COPD therapy is relatively ineffective 16,17 and since a significant number of COPD patients will die of a cardiovascular comorbidity, drugs that target the lung and the cardiovascular system concurrently may be an advantageous therapeutic strategy. Epidemiological studies have suggested that angiotensin converting enzyme (ACE) inhibitors which are used to treat hypertension and cardiac failure (common comorbidities of COPD), may benefit COPD, by reducing mortality and exacerbations 18–21 . In addition, COPD patients on angiotensin II receptor blockers (ARBs) had reduced rates of pneumonia and mortality compared to COPD patients on ACE inhibitors 22 .…”

Section: Introductionmentioning

confidence: 99%

Losartan does not inhibit cigarette smoke-induced lung inflammation in mice

Hepworth

Passey

Seow

et al. 2019

Sci Rep

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Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease largely caused by cigarette smoking (CS) and is characterized by lung inflammation and airflow limitation that is not fully reversible. Approximately 50% of people with COPD die of a cardiovascular comorbidity and current pharmacological strategies provide little benefit. Therefore, drugs that target the lung and the cardiovascular system concurrently may be an advantageous therapeutic strategy. The aim of this study was to see whether losartan, an angiotensin-II AT1a receptor antagonist widely used to treat hypertension associated with cardiovascular disease, protects against CS-induced lung inflammation in mice. Male BALB/c mice were exposed to CS for 8 weeks and treated with either losartan (30 mg/kg) or vehicle daily. Mice were euthanized and bronchoalveolar lavage fluid (BALF) inflammation, and whole lung cytokine, chemokine and protease mRNA expression assessed. CS caused significant increases in BALF total cells, macrophages, neutrophils and whole lung IL-6, TNF-α, CXCL-1, IL-17A and MMP12 mRNA expression compared to sham-exposed mice. However, losartan only reduced CS-induced increases in IL-6 mRNA expression. Angiotensin-II receptor expression was reduced in lung tissue from CS-exposed mice. In conclusion, losartan did not inhibit CS-induced BALF cellularity despite reducing whole lung IL-6 mRNA and Ang-II receptor expression.

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Section: Introductionmentioning

confidence: 99%

Losartan does not inhibit cigarette smoke-induced lung inflammation in mice

Hepworth

Passey

Seow

et al. 2019

Sci Rep

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“…The characteristics of eligible studies are displayed in table 1 and online supplemental table 2 . Twelve studies 9–11 19 20 22–24 26 28 29 32 were conducted in Europe and North America, and eight studies 8 21 25 27 30 31 33 34 were conducted in Asia. These studies were published between 2006 and 2022.…”

Section: Resultsmentioning

confidence: 99%

Could patients with chronic obstructive pulmonary disease benefit from renin angiotensin system inhibitors? A meta-analysis

Huang

Miao

et al. 2023

BMJ Open Resp Res

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BackgroundChronic obstructive pulmonary disease (COPD) is considered related to chronic systemic inflammation. Renin angiotensin system (RAS) inhibitor, exerting an anti-inflammatory action in many systems, has been demonstrated relevant to the pathogenesis of COPD. However, the association between RAS inhibitor use and prognosis of patients with COPD remains controversial. Therefore, we conducted a meta-analysis and systematic review to summarise current evidence.Material and methodsDatabases, including Medline, Embase, Web of Science and Cochran Library, were searched for eligible studies by the end of 30 September 2022. Observational studies or randomised controlled trials (RCTs) that investigated the association of RAS inhibitor use with prognosis of COPD (mortality or risk of acute exacerbation) were selected. The Newcastle-Ottawa Scale was used for quality assessment of observational studies, while the Cochrane risk-of-bias tool was used to assess the quality of RCTs. Statistical analyses were performed using Stata V.15. We selected relative risk (RR) with 95% CI as the effect measure. Heterogeneity was assessed by I-squared (I2) statistics. The funnel plot was used for visual assessment of publication bias.ResultsA total of 20 studies with 5 51 649 subjects were included in the meta-analysis. The overall analysis indicated that RAS inhibitor use decreased the risk of death in patients with COPD (RR: 0.69, 95% CI: 0.61 to 0.78). Subgroup analyses were conducted according to comorbidities, race and type of RAS inhibitors, and the results kept consistent. However, in the pooled analysis of prospective studies, RAS inhibitor use did not significantly decrease the mortality (RR: 0.89, 95% CI: 0.78 to 1.02). Additionally, the risk of exacerbations of COPD did not decrease in patients who were prescribed RAS inhibitors (RR: 0.99, 95% CI: 0.80 to 1.23). The funnel plot indicated significant publication bias.ConclusionRAS inhibitor use seemed to be associated with a reduction of mortality in patients with COPD. However, the available evidence is weak due to potential biases from retrospective studies and the heterogeneity across included studies.

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“…Similarly, Su et al [23] reported a lower mortality rate with ARB use in patients with COPD-HF overlap. Moreover, previous studies have reported the bene ts of ARB use, including decreased mortality rate [24] and lower risk of acute exacerbation and pneumonia [25], in COPD patients. In our study, stroke as a comorbidity and oral corticosteroid use were two independent risk factors for a shorter duration to the rst all-cause readmission.…”

Section: Discussionmentioning

confidence: 99%

Influence of Chronic Obstructive Pulmonary Disease on Long-term Hospitalization and Mortality in Patients with Heart Failure with Reduced Ejection Fraction

Lin

Yeh

Lin

et al. 2022

Preprint

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Background: Heart failure with reduced ejection fraction (HFrEF) can coexist with chronic obstructive pulmonary disease (COPD), which complicates the clinical situation and worsens quality of life. The study used standard diagnostic criteria for detecting COPD in hospitalized HFrEF patients and to determine the impact of other comorbidities and medications on the long-term outcomes of HFrEF + COPD patients.Methods: We retrospectively recruited patients hospitalized due to HFrEF in a tertiary medical center and examined and followed up clinical outcomes, including length of hospital stay, mortality, and readmission episodes, for a 5-year period. Risk factors for mortality were analyzed using multivariate analysis. Results: Of the 118 hospitalized HFrEF study participants, 68 had concurrent COPD whereas 50 did not. There was a significant increase in the male predominance, smoking history, lower left ventricular ejection fraction, and higher hemoglobin level and increased length of hospital stay in the HF + COPD group than in the HF-only group. In multivariate analysis, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) use independently predicted 5-year all-cause mortality. Oral corticosteroid use and stroke as a comorbidity were independently associated with a shorter time to the first readmission episode. Conclusion: In HFrEF patients, COPD was associated with a prolonged length of hospital stay. ACEI/ARB use was independently associated with a beneficial effect on survival in HF patients with COPD. Long-term oral corticosteroid use in patients with both HF and COPD should be crucially evaluated to determine the clinical benefit and disadvantages.

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Effect of angiotensin 2 receptor blockers on chronic obstructive lung disease mortality: A retrospective cohort study

Cited by 11 publications

References 18 publications

Losartan does not inhibit cigarette smoke-induced lung inflammation in mice

Losartan does not inhibit cigarette smoke-induced lung inflammation in mice

Could patients with chronic obstructive pulmonary disease benefit from renin angiotensin system inhibitors? A meta-analysis

Influence of Chronic Obstructive Pulmonary Disease on Long-term Hospitalization and Mortality in Patients with Heart Failure with Reduced Ejection Fraction

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