235 Do Cardiovascular Drugs Reduce The Rates Of Exacerbations And Community-Acquired Pneumonia In Primary Care Patients With Copd?

Conference: 
Author(s): 
Frans Rutten - Julius Centre, University Medical Centre Utrecht
N.P.A. Zuithoff - Julius Centre, University Medical Centre Utrecht
A.P.E. Sachs - Julius Centre, University Medical Centre Utrecht
A.W. Hoes - Julius Centre, University Medical Centre Utrecht
Text: 
Oral Communication
In COPD the renin-angiotensin and sympathetic nervous system is activated. These systems possibly play a role in the onset of exacerbations and pneumonia. Thus, angiotensin converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARBs), and beta-blockers could elicit beneficial effects on these outcomes.
Objective: To compare the effect of ACE-I or ARBs, and beta-blockers on exacerbation and community-acquired pneumonia rates in primary care patients with COPD.
Methods: Data were obtained from computerised medical records of 22 general practices. We analysed patients aged >50 years during the period 1996-2003. We used multivariate Cox regression analysis to calculate adjusted hazard ratios (HR) of exacerbations and pneumonia, after adjustment for age, gender, cardiovascular events, diabetes, and other cardiovascular drugs.
Results: 2022 COPD patients were included, mean follow-up 5.7 years. 839 (42%) patients experienced at least one exacerbation and 419 (21%) pneumonia. Mean age was 65.1 (SD 11.2) years and 53% were male. 29% used ACE-I or ARBs and 24% beta-blockers. Those who used ACE-I/ARBs the adjusted HRs for exacerbations was 1.11 (95%CI 0.95-1.30) and 1.03 (95%CI 0.83-1.29) for pneumonia. For beta-blockers the adjusted HRs were 0.58 (95%CI 0.48-0.69) and 0.85 (95%CI 0.66-1.08), respectively.
Conclusion: beta-blockers reduce the rates of exacerbations and possibly community-acquired pneumonia in patients with COPD. RCTs are warranted to validate our findings since residual confounding in observational studies cannot be fully excluded.
Literature: 
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Do cardiovascular drugs reduce the rates of exacerbations and community-acquired pneumonia in primary care patients with COPD?