J Korean Med Sci.  2022 Aug;37(32):e248. 10.3346/jkms.2022.37.e248.

The Association Between Antihypertensive Drug Use and Hospitalization for Pneumonia in the General Population: A Case-Crossover Study Using the National Health Insurance Database of Korea

• Park D
• Yun JH
• Chun S
• Oh BM
• Kim HS

• KMID: 2532322
• DOI: http://doi.org/10.3346/jkms.2022.37.e248

Abstract

Background
Previous studies have reported an association between pneumonia risk and the use of certain drugs. We investigated the relationship between antihypertensive drugs and pneumonia in the general population.
Methods
This case-crossover study utilized the nationwide data of South Korea. We included participants who were hospitalized for pneumonia. A single case period was defined as 30 days before pneumonia onset, and two control periods were established (90–120 and 150–180 days before pneumonia onset). Further, we performed sensitivity and subgroup analyses (according to the presence of diabetes, documented disability, and whether participants were aged ≥ 70 years). We used conditional logistic regression models adjusted for covariates, such as angiotensin-converting-enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), other antihypertensives, statins, antipsychotics, benzodiazepine, and the number of outpatient visits.
Results
In total, 15,463 subjects were included in this study. ACE inhibitors (adjusted odds ratio [aOR], 0.660; 95% confidence interval [CI], 0.558–0.781), ARBs (aOR, 0.702; 95% CI, 0.640–0.770), and other antihypertensive drugs (aOR, 0.737; 95% CI, 0.665–0.816) were significantly associated with reduced pneumonia risk. Subgroup analyses according to the presence of diabetes mellitus, documented disability, and whether participants were aged ≥ 70 years consistently showed the association of antihypertensives with a reduced risk of hospitalization for pneumonia.
Conclusion
All antihypertensive drug types were related to a lower risk of hospitalization for pneumonia in the general population. Our results implied that frequent medical service usage and protective immunity were primarily related to a reduced risk of pneumonia in the general population of South Korea.

Keyword

Pneumonia; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Population Health

Figure

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  Fig. 1 The case-crossover study design. Case period was defined as a 30-day window before the index date of new-onset pneumonia. Two control periods were each defined as a 30-day window in a 30-day interval. A 60-day washout period was set between the end of the last control period and the start of the case period.

• 

  Fig. 2 The sensitivity test design. The case and two control periods were changed from 30 to 45 or 60 days.

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