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Incidence of angio-oedema associated with ARBs, ACE inhibitors, and aliskiren

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e6941 (Published 17 October 2012) Cite this as: BMJ 2012;345:e6941

Angio-oedema is a well known side effect of drugs that target the renin-angiotensin system. Among the three different drug classes, absolute risk looked lowest for angiotensin receptor blockers (ARBs) in a recent analysis of claims data from 17 health plans across the US (1.66 cases per 1000 treated adults per year, 95% CI 1.47 to 1.86). Comparable figures were 4.38 (4.24 to 4.54) for angiotensin converting enzyme (ACE) inhibitors, and 4.67 (1.88 to 9.63) for aliskiren, a direct inhibitor of renin.

All three drug classes were associated with a significantly higher incidence of angio-oedema than β blockers in fully adjusted analyses. Again, relative risks were lower for adults taking ARBs (hazard ratio 1.16, 1.00 to 1.34) than for those taking ACE inhibitors (3.04, 2.81 to 3.27) or aliskiren (2.85, 1.34 to 6.04).

The analyses included nearly two million adults exposed to ACE inhibitors, nearly half a million exposed to ARBs, and a total of 4511 reported cases of angio-oedema. The new estimates are probably the most reliable so far, say the authors. Roughly two thirds of all cases of angio-oedema occurred during the first 90 days of treatment. Risks associated with ACE inhibitors were highest for women and for adults aged 65 years or more.

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Cite this as: BMJ 2012;345:e6941