Relationship between angiotensin-converting enzyme inhibitors and angiotensin receptor blockers prescribing and delirium in the ICU-A secondary analysis.
J Am Geriatr Soc. 2023 Mar 11 [Online ahead of print]JA

Abstract

BACKGROUND

Studies suggest Angiotensin-Converting Enzyme inhibitors (ACEI) and Angiotensin Receptor Blockers (ARB) may slow the decline of memory function in individuals with mild to moderate Alzheimer's disease by regulating migroglial activation and oxidative stress within the brain's reticular activating system. Therefore, we evaluated the relationship between delirium prevalence and being prescribed ACEI and ARB in participants admitted to the intensive care units (ICU).

METHODS

A secondary analysis of data from two parallel pragmatic randomized controlled trials was performed. ACEI and ARB exposure was defined as being prescribed an ACEI or an ARB within six months prior to the ICU admission. The primary endpoint was the first positive delirium assessment based on Confusion Assessment Method for the ICU (CAM-ICU) for up to thirty days.

RESULTS

A total of 4791 patients admitted to the medical, surgical, and progressive ICU and screened for eligibility for the parent studies between February 2009 and January 2015 from two level 1 trauma and one safety net hospital in a large urban academic health system were included. Delirium rates in the ICU were not significantly different among participants with no exposure to ACEI/ARB (12.6%), or exposure to ACEI (14.4%), ARB (11.8%), or ACEI and ARB in combination (15.4%) in six months prior to the ICU admission. Exposure to ACEI (OR = 0.97[0.77, 1.22]), ARB (OR = 0.70 [0.47, 1.05]), or both (OR = 0.97 [0.33, 2.89]) in six months prior to ICU admission was not significantly associated with odds of delirium during the ICU admission after adjusting for age, gender, race, co-morbidities, and insurance status.

CONCLUSIONS

While the impact of ACEI and ARB exposure prior to the ICU admission was not associated with the prevalence of delirium in this study, further research is needed to fully understand the impact of antihypertensive medications on delirium.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Mulkey MA

College of Nursing, University of South Carolina, Columbia, South Carolina, USA.

Khan S

Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University-Purdue University, Indianapolis, Indiana, USA. School of Medicine, Indiana University, Indianapolis, Indiana, USA. Center for Aging Research, Indiana University, Indianapolis, Indiana, USA. Indiana University Center of Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA.

Perkins A

School of Medicine, Indiana University, Indianapolis, Indiana, USA. Department of Biostatistics and Health Data Science, Indiana University-Purdue University, Indianapolis, Indiana, USA.

Gao S

School of Medicine, Indiana University, Indianapolis, Indiana, USA. Department of Biostatistics and Health Data Science, Indiana University-Purdue University, Indianapolis, Indiana, USA.

Wang S

School of Medicine, Indiana University, Indianapolis, Indiana, USA. Department of Psychiatry, Department of Biostatistics and Health Data Science, Indianapolis, Indiana, USA.

Campbell N

Center for Aging Research, Indiana University, Indianapolis, Indiana, USA. Indiana University Center of Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA. Department of Pharmacy Practice, Purdue University, Lafayette, Indiana, USA.

Khan B

Pub Type(s)

Journal Article

Language

eng

PubMed ID

36905601

Citation

Mulkey, Malissa A., et al. "Relationship Between Angiotensin-converting Enzyme Inhibitors and Angiotensin Receptor Blockers Prescribing and Delirium in the ICU-A Secondary Analysis." Journal of the American Geriatrics Society, 2023.

Mulkey MA, Khan S, Perkins A, et al. Relationship between angiotensin-converting enzyme inhibitors and angiotensin receptor blockers prescribing and delirium in the ICU-A secondary analysis. J Am Geriatr Soc. 2023.

Mulkey, M. A., Khan, S., Perkins, A., Gao, S., Wang, S., Campbell, N., & Khan, B. (2023). Relationship between angiotensin-converting enzyme inhibitors and angiotensin receptor blockers prescribing and delirium in the ICU-A secondary analysis. Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.18285

Mulkey MA, et al. Relationship Between Angiotensin-converting Enzyme Inhibitors and Angiotensin Receptor Blockers Prescribing and Delirium in the ICU-A Secondary Analysis. J Am Geriatr Soc. 2023 Mar 11; PubMed PMID: 36905601.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Relationship between angiotensin-converting enzyme inhibitors and angiotensin receptor blockers prescribing and delirium in the ICU-A secondary analysis. AU - Mulkey,Malissa A, AU - Khan,Sikandar, AU - Perkins,Anthony, AU - Gao,Sujuan, AU - Wang,Sophia, AU - Campbell,Noll, AU - Khan,Babar, Y1 - 2023/03/11/ PY - 2023/01/14/revised PY - 2022/07/05/received PY - 2023/01/25/accepted PY - 2023/3/11/entrez PY - 2023/3/12/pubmed PY - 2023/3/12/medline KW - ACE inhibitor KW - angiotensin recepter blocker KW - critical care KW - delirium KW - intensive care JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc N2 - BACKGROUND: Studies suggest Angiotensin-Converting Enzyme inhibitors (ACEI) and Angiotensin Receptor Blockers (ARB) may slow the decline of memory function in individuals with mild to moderate Alzheimer's disease by regulating migroglial activation and oxidative stress within the brain's reticular activating system. Therefore, we evaluated the relationship between delirium prevalence and being prescribed ACEI and ARB in participants admitted to the intensive care units (ICU). METHODS: A secondary analysis of data from two parallel pragmatic randomized controlled trials was performed. ACEI and ARB exposure was defined as being prescribed an ACEI or an ARB within six months prior to the ICU admission. The primary endpoint was the first positive delirium assessment based on Confusion Assessment Method for the ICU (CAM-ICU) for up to thirty days. RESULTS: A total of 4791 patients admitted to the medical, surgical, and progressive ICU and screened for eligibility for the parent studies between February 2009 and January 2015 from two level 1 trauma and one safety net hospital in a large urban academic health system were included. Delirium rates in the ICU were not significantly different among participants with no exposure to ACEI/ARB (12.6%), or exposure to ACEI (14.4%), ARB (11.8%), or ACEI and ARB in combination (15.4%) in six months prior to the ICU admission. Exposure to ACEI (OR = 0.97[0.77, 1.22]), ARB (OR = 0.70 [0.47, 1.05]), or both (OR = 0.97 [0.33, 2.89]) in six months prior to ICU admission was not significantly associated with odds of delirium during the ICU admission after adjusting for age, gender, race, co-morbidities, and insurance status. CONCLUSIONS: While the impact of ACEI and ARB exposure prior to the ICU admission was not associated with the prevalence of delirium in this study, further research is needed to fully understand the impact of antihypertensive medications on delirium. SN - 1532-5415 UR - https://www.unboundmedicine.com/medline/citation/36905601/Relationship_between_angiotensin_converting_enzyme_inhibitors_and_angiotensin_receptor_blockers_prescribing_and_delirium_in_the_ICU_A_secondary_analysis_ DB - PRIME DP - Unbound Medicine ER -

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Relationship between angiotensin-converting enzyme inhibitors and angiotensin receptor blockers prescribing and delirium in the ICU-A secondary analysis.J Am Geriatr Soc. 2023 Mar 11 [Online ahead of print]JA