BACKGROUND:Angiotensin-converting enzyme (ACE) inhibitors prevent the expansion and rupture of aortic aneurysms in animals. We investigated the association between ACE inhibitors and rupture in patients with abdominal aortic aneurysms. METHODS:We did a population-based case-control study of linked administrative databases in Ontario, Canada. The sample included consecutive patients older than 65 (n=15,326) admitted to hospital with a primary diagnosis of ruptured or intact abdominal aortic aneurysm between April 1, 1992, and April 1, 2002. FINDINGS:Patients who received ACE inhibitors before admission were significantly less likely to present with ruptured aneurysm (odds ratio [OR] 0.82, 95% CI 0.74-0.90) than those who did not receive ACE inhibitors. Adjustment for demographic characteristics, risk factors for rupture, comorbidities, contraindications to ACE inhibitors, measures of health-care use, and aneurysm screening yielded similar results (0.83, 0.73-0.95). Consistent findings were noted in subgroups at high risk of rupture, including patients older than 75 years and those with a history of hypertension. Conversely, such protective associations were not observed for beta blockers (1.02, 0.89-1.17), calcium channel blockers (1.01, 0.89-1.14), alpha blockers (1.15, 0.86-1.54), angiotensin receptor blockers (1.24, 0.71-2.18), or thiazide diuretics (0.91, 0.78-1.07). INTERPRETATION:ACE inhibitors are associated with a reduced risk of ruptured abdominal aortic aneurysm, unlike other antihypertensive agents. Randomised trials of ACE inhibitors for prevention of aortic rupture might be warranted.

译文

背景:血管紧张素转换酶(ACE)抑制剂可防止动物主动脉瘤的扩张和破裂。我们调查了腹主动脉瘤患者中ACE抑制剂与破裂之间的关系。
方法:我们在加拿大安大略省的相关行政数据库中进行了基于人群的病例对照研究。该样本包括1992年4月1日至2002年4月1日之间入院的65岁以上的连续患者(n = 15,326),其主要诊断为腹主动脉瘤破裂或完整。
结果:与未接受ACE抑制剂的患者相比,入院前接受ACE抑制剂的患者出现动脉瘤破裂的可能性显着降低(优势比[OR] 0.82,95%CI 0.74-0.90)。对人口统计学特征,破裂危险因素,合并症,ACEI禁忌症,保健措施和动脉瘤筛查的调整也得出了相似的结果(0.83,0.73-0.95)。在高破裂风险的亚组中发现了一致的发现,包括年龄超过75岁的患者和有高血压病史的患者。相反,对于β受体阻滞剂(1.02,0.89-1.17),钙通道阻滞剂(1.01,0.89-1.14),α受体阻滞剂(1.15,0.86-1.54),血管紧张素受体阻滞剂(1.24,0.71-2.18)未观察到这种保护性关联。 ,或噻嗪类利尿剂(0.91、0.78-1.07)。
解释:与其他降压药不同,ACE抑制剂与降低腹主动脉瘤破裂的风险有关。 ACE抑制剂预防主动脉破裂的随机试验可能是必要的。

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