ARBs associated with higher suicide risk than ACEIs

  • JAMA Netw Open

  • de Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Angiotensin receptor blockers (ARBs) were associated with a higher risk for suicide than angiotensin-converting enzyme inhibitors (ACEIs) in adults aged ≥66 years.

Why this matters

  • ACEIs and ARBs are widely used to manage hypertension, chronic kidney disease, heart failure, and diabetes, but these findings suggest ACEIs may be more preferable, especially in patients who are otherwise at increased suicide risk.

Study design

  • Population-based nested case-control study of individuals aged ≥66 years (suicide cases; n=964; control individuals, n=3856).
  • Funding: Ontario Ministry of Health and Long-Term Care Health System Research Fund; ICES.

Key results

  • 26.0% of cases and 74.0% of control individuals were exposed to ARBs; 18.4% of cases and 81.6% of control individuals were exposed to ACEIs.
  • ARBs were associated with higher risk for suicide than ACEIs (aOR, 1.63; 95% CI, 1.33-2.00).
  • Sensitivity analysis confirmed the findings (OR, 1.60; 95% CI, 1.29-1.98).

Limitations

  • Preliminary findings need to be confirmed.
  • Generalizability of findings to younger population unknown.

Coauthored with Chitra Ravi, MPharm