J Korean Med Sci.  2022 Apr;37(15):e112. 10.3346/jkms.2022.37.e112.

Association Between Antihypertensive Use and Hospitalized Pneumonia in Patients With Stroke: A Korean Nationwide Population-Based Cohort Study

• Yun JH
• Rhee SY
• Chun S
• Kim HS
• Oh BM

• KMID: 2528172
• DOI: http://doi.org/10.3346/jkms.2022.37.e112

Abstract

Background
We aimed to examine the association between antihypertensive use and the incidence of hospitalized pneumonia in patients with a history of stroke.
Methods
In this case-crossover study, we obtained data from the Korean National Health Insurance Service–National Sample Cohort database. We included the data of patients with history of stroke who were admitted with a disease code of pneumonia. We analyzed the patients’ exposure to antihypertensives in the 30 (single case period), 90–120, and 150–180 days (2 control periods) before the onset of pneumonia using conditional logistic regression analysis. Additionally, sensitivity analysis and subgroup analysis according to diabetes status, age, and documented disability were performed.
Results
Angiotensin II receptor blocker (ARB) use was associated with a reduced risk of hospitalized pneumonia (adjusted odds ratio [OR] [95% confidence interval; 95% CI]: 0.718 [0.576–0.894]). However, the use of angiotensin converting enzyme inhibitors and other antihypertensives were not associated with a change in hospitalized pneumonia incidence (adjusted OR [95% CI]: 0.902, [0.603–1.350] and 0.788 [0609–1.018], respectively). Subgroup analysis revealed that ARB use was associated with a reduced incidence of hospitalized pneumonia in patients with a history of stroke who were older than 65 years, but not in younger (≤ 65 years) group (adjusted OR [95% CI]: 0.687 [0.536–0.880]).
Conclusion
ARB use is associated with a reduced incidence of hospitalized pneumonia in patients with a history of stroke, especially in older adults.

Keyword

Pneumonia; Stroke; Angiotensin Receptor Antagonists; Angiotensin-Converting; Enzyme Inhibitors; Antihypertensive Agents

Figure

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  Fig. 1 The case-crossover study design. The case period was defined as 30 days before the index date of first onset pneumonia. Two control periods were defined as 30 days with 30 day intervals, 90 to 120 days and 150 to 180 days before the index date, respectively.

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  Fig. 2 The sensitivity test design. The time period of the case period and two control periods were changed from 30 days to 60 days.

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