Association between angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and major psychiatric disorders

Highlights

• The report represents a substantial collection of data concerning an important topic of the RAS inhibitor associated psychologic illness.

• Overall this is an investigation with the advantage of a very large study population that allows the authors to look at many subgroups/factors with statistical significance.

• Strengths included large patient population, access to nearly the entire Taiwanese population, and well matched patients.

Abstract

Objective

To exam the association between major psychiatry illness and angiotensin-converting enzyme inhibitor (ACEI) versus angiotensin receptor blocker (ARB) users in a head-to-head comparison manner.

Methods

Study design is a retrospective cohort study utilizing available data through the National Health Insurance database. 13,974 ACEI users and 13,974 propensity score matching ARB users were included to look at the future incident psychiatry illness. The Kaplan-Meier method was used to assess the cumulative curves and were tested by the Log-rank test. The crude hazard ratio (HR) and adjusted HR were estimated by univariable and multivariable Cox proportional hazard model.

Results

After controlling for the confounders, ACEI users had a higher risk of major psychiatric disorders than ARB users, (adjusted HR = 1.07; 95% CI = 1.02, 1.13). The cumulative incidence of major psychiatric disorders for ACEI cohort was significantly higher than that of ARB cohort (p-value = 0.001).

Conclusions

Compared to ARB users, ACEI users are prone to major psychiatry illness development.

Introduction

Post marketing surveillance has gained widely attraction since most randomized controlled trials are highly selected and controlled (Sherman et al., 2016; de Lusignan et al., 2015; Stanley, 2007; Søren et al., 2009). In this regard, contemporary real-world observational studies is helpful in consolidation the investigation of efficacy, safety and adverse events of medications (Sherman et al., 2016; de Lusignan et al., 2015; Stanley, 2007; Søren et al., 2009). In the field of vascular biology, renin-angiotensin system (RAS) inhibitor, including angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) are widely used since several landmark trials have proved, confirmed and affirmed their therapeutic effect (López-Sendón et al., 2004, Yancy et al., 2020, 2016, ). Indeed, pleiotropic effects of RAS inhibitor have been proposed, including the psychoprotective effect (; Krysiak and Okopień, 2008; Ismail et al., 2010, Vian et al., 2017). However, one recent registry raised the concern that ARB users have an increased incidence of suicide (Mamdani et al., 2019). To evaluate the association between psychiatry illness and ACEI versus ARB users in a head-to-head comparison manner, we report in a retrospective observational study from a large Taiwanese registry to investigate the incidence of new-onset psychiatric illness after RAS inhibitor consumption.