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Effect of Antihypertensive Medications on Sepsis-Related Outcomes: A Population-Based Cohort Study*

Kim, Joohae MD1; Kim, Young Ae PhD2; Hwangbo, Bin PhD1; Kim, Min Jeong BM3; Cho, Hyunsoon PhD4,5; Hwangbo, Yul MD6; Lee, Eun Sook PhD3

doi: 10.1097/CCM.0000000000003654
Online Clinical Investigations
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Objectives: Although the effect of antihypertensive agents on sepsis has been studied, evidence for survival benefit was limited in the literature. We investigated differences in sepsis-related outcomes depending on the antihypertensive drugs given prior to sepsis in patients with hypertension.

Design: Population-based cohort study.

Setting: Sample cohort Database of the National Health Insurance Service from 2003 to 2013 in South Korea.

Patients: Patients over 30 years old who were diagnosed with sepsis after receiving hypertension treatment.

Interventions: None.

Measurements and Main Results: Primary outcomes, 30-day and 90-day mortality rates, were analyzed for differences among three representative antihypertensive medications: angiotensin- converting enzyme inhibitors or angiotensin II receptor blockers, calcium channel blockers, and thiazides. In total, 4,549 patients diagnosed with hypertension prior to hospitalization for sepsis were identified. The 30-day mortality was significantly higher among patients who did not receive any medications within 1 month before sepsis (36.8%) than among patients who did (32.0%; p < 0.001). The risk for 90-days mortality was significantly lower in prior angiotensin-converting enzyme inhibitors or angiotensin II receptor blocker users (reference) than in other drug users (odds ratio, 1.27; 95% CI, 1.07–1.52). There was no difference in the risk for 30-day and 90-day mortality depending on whether calcium channel blockers or thiazides were used. Use of calcium channel blockers was associated with a decreased risk for inotropic agent administration, compared with those of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (odds ratio, 1.23; 95% CI, 1.05–1.44) and thiazides (odds ratio, 1.33; 95% CI, 1.12–1.58).

Conclusions: In patients with sepsis, lower mortality rate was associated with prior use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers not with use of calcium channel blockers or thiazides. The requirement of inotropic agents was significantly lower in prior use of calcium channel blockers, although the survival benefits were not prominent.

1Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.

2Cancer Survivorship Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea.

3Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.

4Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.

5Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, Korea.

6Center for Thyroid Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.

*See also p. 739.

Drs. J. Kim and Y. A. Kim equally contributed to this work.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by a grant from the National R&D Program for Cancer Control, Ministry of Health and Welfare, Republic of Korea (1520240).

Dr. Lee disclosed work for hire. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: hbb@ncc.re.kr

Copyright © 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.