Recurrent angiotensin-converting enzyme inhibitor--associated angioedema
N. J. Brown, M. Snowden and M. R. Griffin
Department of Medicine, Vanderbilt University, Nashville, Tenn 37232-6602, USA. nancy.brown@mcmail.vanderbilt.edu
CONTEXT: Angiotensin-converting enzyme (ACE) inhibitors are associated with
an increased risk of angioedema, but the risk of recurrent angioedema if
treatment is continued is not known. OBJECTIVE: To test the hypothesis that
the association between ACE inhibitor use and angioedema may not be
recognized and to determine characteristics of angioedema associated with
continued use of ACE inhibitors. DESIGN: Retrospective cohort study.
SETTING: Tennessee Medicaid program. PATIENTS: Medicaid enrollees aged 15
years or older who used an ACE inhibitor and had a first documented episode
of angioedema between 1986 and 1992 were followed up for recurrent episodes
through June 1993. MEASUREMENTS AND MAIN RESULTS: We previously identified
82 patients with a first confirmed diagnosis of angioedema during 51 752
person-years of ACE inhibitor use in this population (1.6 per 1000
person-years). Among these 82 patients, there were 16 outpatient
recurrences of angioedema among 13 patients during 189 patient-years of
follow-up (8.5 per 100 patient-years). The rate of angioedema was much
higher in users of ACE inhibitors with continued exposure (18.7 per 100
patient-years) than in those whose use of the drug was discontinued (1.8
per 100 patient-years) (P=.001). Review of the medical records for patients
taking ACE inhibitors who had recurrent angioedema revealed that physicians
attributed angioedema to a number of causes not related to ACE inhibitor
use, even after multiple recurrences. CONCLUSION: Continuing use of ACE
inhibitors in spite of angioedema results in a markedly increased rate of
angioedema recurrence with serious morbidity.
