angiotensin-converting enzyme inhibitors

Samahjabi's picture

Effect of Prestroke Use of Angiotensin-Converting Enzyme Inhibitors Alone Versus Combination with Antiplatelets and Statin on Ischemic Stroke Outcome

Journal Title, Volume, Page: 
Clinical Neuropharmacology: November/December 2011 - Volume 34 - Issue 6 - p 234–240 doi: 10.1097/WNF.0b013e3182348abe
Year of Publication: 
2012
Authors: 
Hassan, Yahaya
Al-Jabi, Samah
Current Affiliation: 
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Aziz, Noorizan Abd
Looi, Irene MBBS
Zyoud, Sa’ed
Preferred Abstract (Original): 

Background: Angiotensin-converting enzyme inhibitors (ACEIs), antiplatelets (APs), and statin are increasingly being prescribed for ischemic stroke prevention.
Objectives: The objective of the study was to examine whether previous combination therapy of ACEI with AP and/or statin has additive effect compared with ACEI alone on functional outcome after ischemic stroke. Furthermore, factors associated with improving functional outcome were investigated.
Methods: Ischemic stroke patients attending a Malaysian hospital in 2008 were categorized according to Barthel Index at discharge. Favorable outcome was defined as Barthel Index of 75 or greater. Data included demographic information, clinical characteristics, and previous medications with particular attention to ACEI, AP, and statin.
Results: Overall, 505 patients were included. Variables associated with good functional outcome were younger age (P = 0.002), first-ever attack (P = 0.016), lacunar (P = 0.015) or posterior circulation infarct stroke subtype (P = 0.034), minor Glasgow Coma Scale (P < 0.001), and previous use of ACEI alone or combined with AP and/or statin (P = 0.002). Using ACEI alone as the reference for ACEI + AP, ACEI + statin, or ACEI + AP + statin combinations, there was no significant difference among combinations on improving functional outcome (P = 0.852)
Conclusions: Prestroke use of ACEI either alone or combined with AP and/or statin was associated with better functional outcome. Previous use of ACEI in combination with AP and/or statin did not significantly differ from ACEI alone in their effect on outcome. Our study provides a potential rationale for optimizing the use of ACEI among individuals at risk of developing ischemic stroke. 

saedzyoud's picture

Effect of Prestroke Use of Angiotensin-Converting Enzyme Inhibitors Alone Versus Combination With Antiplatelets and Statin on Ischemic Stroke Outcome

Journal Title, Volume, Page: 
Clinical Neuropharmacology; DOI: 10.1097/WNF.0b013e3182348abe
Year of Publication: 
2011
Authors: 
Yahaya Hassan
Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Tekno- logi MARA (UiTM), Puncak Alam Campus, Bandar Puncak Alam, Selangor Darul Ehsan
Samah W. Al-Jabi
Clinical Pharmacy Program, School of Pharmaceutical Sci- ences, Universiti Sains Malaysia (USM), Penang, Malaysia
Noorizan Abd Aziz
Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Tekno- logi MARA (UiTM), Puncak Alam Campus, Bandar Puncak Alam, Selangor Darul Ehsan
Irene Looi
Clinical Re- search Centre, Hospital Pulau Pinang
Sa’ed H. Zyoud
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Current Affiliation: 
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Preferred Abstract (Original): 

Background: Angiotensin-converting enzyme inhibitors (ACEIs), antiplatelets (APs), and statin are increasingly being prescribed for ischemic stroke prevention.
Objectives: The objective of the study was to examine whether previous combination therapy of ACEI with AP and/or statin has additive effect compared with ACEI alone on functional outcome after ischemic stroke. Furthermore, factors associated with improving functional outcome were investigated.  Methods: Ischemic stroke patients attending a Malaysian hospital in 2008 were categorized according to Barthel Index at discharge. Favorable outcome was defined as Barthel Index of 75 or greater. Data included demographic information, clinical characteristics, and previous medications with particular attention to ACEI, AP, and statin.
Results: Overall, 505 patients were included. Variables associated with good functional outcome were younger age (P = 0.002), first-ever attack (P = 0.016), lacunar (P = 0.015) or posterior circulation infarct stroke subtype (P = 0.034), minor Glasgow Coma Scale (P < 0.001), and previous use of ACEI alone or combined with AP and/or statin (P = 0.002). Using ACEI alone as the reference for ACEI + AP, ACEI + statin, or ACEI + AP + statin combinations, there was no significant difference among combinations on improving functional outcome (P = 0.852).
Conclusions: Prestroke use of ACEI either alone or combined with AP and/or statin was associated with better functional outcome. Previous use of ACEI in combination with AP and/or statin did not significantly differ from ACEI alone in their effect on outcome. Our study provides a potential rationale for optimizing the use of ACEI among individuals at risk of developing ischemic stroke.

Samahjabi's picture

Impact of Angiotensin-Converting Enzyme Inhibitors Administration Prior to Acute Ischemic Stroke Onset on In-Hospital Mortality

Journal Title, Volume, Page: 
J Cardiovasc Pharmacol Ther. 2010 Sep;15(3):274-81. Epub 2010 Jul 12
Year of Publication: 
2011
Authors: 
Yahaya Hassan
Clinical Pharmacy Program, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang, Malaysia
Noorizan Abd Aziz
Clinical Pharmacy Program, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang, Malaysia
Samah W. Al-Jabi
Clinical Pharmacy Program, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang, Malaysia
Current Affiliation: 
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Irene Looi
Clinical Research Centre, Hospital Pulau Pinang, Penang, Malaysia
Sa'ed H. Zyoud
Poison Control and Drug Information Centre, An-Najah National University, Nablus, Palestine
Preferred Abstract (Original): 

Introduction: Angiotensin-converting enzyme inhibitors (ACEIs) have shown promising results in decreasing the incidence and the severity of ischemic stroke in populations at risk and in improving ischemic stroke outcomes.
Objectives: The objectives of this study were to investigate the impact of ACEI use before ischemic stroke onset on in-hospital mortality and to identify the independent predictors of in-hospital mortality among patients with ischemic stroke. Methods and Materials: A retrospective cohort study of all patients with acute ischemic stroke attending the hospital from June 1, 2008 to November 30, 2008 was performed. Data were collected from medical records and included demographic information, diagnostic information, risk factors, previous ACEI use, and vital discharge status. Statistical Package for Social Sciences (SPSS) version 15 was used for data analysis. Results: A total of 327 patients with acute ischemic stroke were studied, of which 119 (36.4%) had documented previous ACEI use. During the study period, 52 (15.9%) of the patients with acute ischemic stroke died in hospital. In-hospital mortality was significantly lower among patients who were on ACEI before the attack (P = 0.002). The independent predictors for in-hospital mortality among patients with ischemic stroke were age ≥65 years (P < .001), the presence of diabetes mellitus (P = .012), renal impairment (P = .002), and heart failure (P = .001). Moreover, prior use of ACEI was an independent predictor for survival after ischemic stroke attack (P < .001).
Conclusion: This study provides evidence that the prophylactic administration of ACEI before ischemic stroke may be a potential life-saving strategy. Furthermore, knowledge of in-hospital mortality predictors is necessary to improve survival rate after acute stroke.

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