Exposure to ACEI and ARB not tied to prevalence of delirium
According to a study published in the Journal of the American Geriatrics Society entitled "Relationship between angiotensin-converting enzyme inhibitors and angiotensin receptor blockers prescribing and delirium in the ICU-A secondary analysis" by Mulkey et al. and colleagues, researchers have concluded that usage of medications like Angiotensin-Converting Enzyme inhibitors (ACEI) and Angiotensin Receptor Blockers (ARB) before admitting a person to the intensive care unit (ICU) does not affect delirium prevalence.
Previous research has suggested that ACE and ARB slow the decline of memory function in patients with a history of mild to moderate Alzheimer's disease. This involves regulating migroglial activation and oxidative stress within the brain's reticular activating system.
The primary purpose of this study was to evaluate the relationship between the prevalence of Delirium and the usage of ACEI and ARB in participants admitted to the ICU.
Researchers performed a secondary data analysis from two parallel pragmatic randomized controlled trials to research the above background. They defined ACEI and ARB exposure as being prescribed an ACEI or an ARB within six months before ICU admission.
The primary endpoint assessed was the first positive delirium assessment based on Confusion Assessment Method for the ICU (CAM-ICU) for up to thirty days.
The key results of the study are:
- Four thousand seven hundred ninety-one patients were admitted to the medical, surgical, and progressive ICU and screened.
- There was no significant difference between the rates of Delirium in the ICU among participants without and with exposure to ACEI/ARB, exposure to ACEI, ARB, or ACEI and ARB in combination constituting 12.6 %, 14.4 %. 11.8 % and 15.4 %
- The OR for exposure to ACEI, ARB or both was 0.97, 0.70 and 0.97, respectively and was not associated with odds of Delirium during the ICU admission.
They said the impact of ACEI and ARB exposure before ICU admission is not associated with delirium prevalence.
Further investigations are warranted to assess the impact of antihypertensive medications on Delirium.
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