Angiotensin-converting enzyme inhibitors (ACEIs) and Angiotensin Receptor Blockers (ARBs) are drug classes that are both commonly used to treat diseases such as high blood pressure, kidney disease and heart failure, although the drug classes work in slightly different ways. Research suggests that mice treated with ACEI were more susceptible to infection by a bacteria named Staphylococcus Aureus (S.Aureus). This raises concern about the risk of S.Aureus infection in humans using ACEI. We will study rates of infection by S.Aureus in patients prescribed ACEIs, as compared with those prescribed ARBs, using other outcomes as ‘controls’ to examine whether any differences seen are actually to differences in health status between patients prescribed the different drug classes.
During the pandemic of coronavirus disease 2019 (COVID-19) hypertension, kidney disease and diabetes have been associated with admission to Intensive Care Units and death, and it has been proposed that ACEI and/or ARB drugs may explain this increased risk. Intensive work to understand whether this is the case is underway. Therefore, we will use our planned analysis to explore and understand whether there are differences in health status between users of ACEI and ARB drugs, which will help interpret studies of these drugs related to COVID-19.
We aim to investigate the association between angiotensin converting enzyme inhibitor (ACEI) prescription and Staphylococcus Aureus (S.Aureus) infection in a cohort study using the Clinical Pracice Research Datalink (CPRD) linked to Hospital Episode Statistics (HES). Among adult patients in HES-linked CPRD from April 1997 to March 2017, we will define users of ACEIs. We consider users of angiotensin II Receptor Blockers (ARBs) as an active comparator group. We will conduct a multivariable Cox regression analysis to compare the ACEI users and ARB users for the first incidence of hospitalisation with a diagnosis of S.Aureus infection. To examine the specificity of the association between ACEI and S.Aureus infection, we will compare the two groups for the incidence of hospitalisation with a diagnosis of sepsis due to other organisms.
Hospitalisation with a diagnosis of S.Aureus infection; Sepsis due to S.Aureus (ICD-10 code A41.0).
Laurie Tomlinson - Chief Investigator - London School of Hygiene & Tropical Medicine ( LSHTM )
Masao Iwagami - Corresponding Applicant - University of Tsukuba
Ian Douglas - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Liam Smeeth - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Patrick Bidulka - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Yun "Angel" Wong - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
HES Admitted Patient Care