Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers are drugs that are commonly prescribed for the treatment of high blood pressure. While these drugs help patients lower their blood pressure, there are concerns that their use might lead to an increased risk of acute pancreatitis, which is a condition characterized by the inflammation of the pancreas. To date, this safety concern has not been thoroughly investigated. Thus, we will conduct a large study using the Clinical Practice Research Datalink to examine whether patients using angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers are at a higher risk of acute pancreatitis. Because acute pancreatitis may be serious, results from this study will provide important information on the safety of these drugs.
Renin-angiotensin-aldosterone system inhibitors are antihypertensive drugs that include angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). While these drugs have clinical benefits, there is conflicting evidence on their effects on acute pancreatitis. On the one hand, some observational studies have associated the use of ACE inhibitors with an increased risk of acute pancreatitis, while others have associated the use of ARBs with a decreased risk of this outcome. Given that acute pancreatitis can be a serious and life-threatening condition, additional studies are needed to investigate the role of ACE inhibitors and ARBs on the incidence of acute pancreatitis. Using the Clinical Practice Research Datalink, the Hospital Episodes Statistics Repository, and the Office for National Statistics, we will address this question by comparing new users of ACE inhibitors and ARBs (separately) with new users of dihydropyridine calcium channel blockers between April 1, 1998 to December 31, 2018, with follow-up until March 31, 2019. Calendar time-specific propensity scores will be estimated and, using standardized mortality ratio weighting, weighted Cox proportional hazards models will be used to estimate hazard ratios with 95% confidence intervals for acute pancreatitis comparing 1) use of ACE inhibitors with use of dihydropyridine calcium channel blockers and 2) use of ARBs with use of dihydropyridine calcium channel blockers, with calendar year as stratification variable. The results from this study will provide much-needed information on the safety of ACE inhibitors and ARBs on the incidence of acute pancreatitis
We will identify all incident hospitalizations for acute pancreatitis events recorded in the HES database (ICD-10 codes: K85.0-K85.3, K85.8, K85.9 in primary position).
Samy Suissa - Chief Investigator - Sir Mortimer B Davis Jewish General Hospital
Laurent Azoulay - Corresponding Applicant - McGill University
Alan Barkun - Collaborator - McGill University
Emily McDonald - Collaborator - McGill University
Hui Yin - Collaborator - Sir Mortimer B Davis Jewish General Hospital
Julie Rouette - Collaborator - McGill University
HES Admitted Patient Care;ONS Death Registration Data