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Treatment With Angiotensin-Converting Enzyme Inhibitors Is Associated With a Reduction in Short-Term Mortality in Older Patients With Acute Ischemic Stroke

¹ Department of Clinical and Experimental Medicine, Section of Internal Medicine, Gerontology & Geriatrics, University of Ferrara, Italy.
² Institute of Gerontology & Geriatrics, University of Perugia, Italy.

Address correspondence to Giovanni Zuliani, MD, PhD, Dipartimento di Medicina Clinica & Sperimentale, Sezione di Medicina Interna, Gerontologia & Geriatria, Universitá degli Studi, via Savonarola n°9, 44100 Ferrara, Italy. E-mail: gzuliani{at}hotmail.com

Background. Stroke is the third cause of death in older people living in Western countries. We tested the hypothesis that angiotensin-converting enzyme inhibitors (A-I) might affect short-term (30 day) mortality in older persons with severe acute ischemic stroke.

Methods. We analyzed data from a retrospective study including 475 consecutive older patients hospitalized for acute ischemic stroke. Mean age was 78.4 ± 9.2 years; 58.2% were female. Stroke type was classified according to the Oxford Community Stroke Project (OCSP).

Results. Mortality rate was 28%. Thirty-two percent of patients were treated with A-I; mortality was 16.5% in patients treated compared with 33.3% in those not treated (² p =.001). The odds ratio for mortality in treated patients was: 0.47 (0.25–0.89) after full adjustment (age, sex, mean diastolic and systolic blood pressure, previous stroke and/or transient ischemic attack, congestive heart failure, atrial fibrillation, diabetes, hypertension, coronary heart disease, and previous treatment with A-I); 0.29 (0.09–0.89) in patients with altered level of consciousness after full adjustment; 0.60 (0.33–1.12) after adjustment for OCSP classification, age, and sex; and 0.30 (0.08–0.97) in total anterior circulation infarction stroke type after full adjustment.

Conclusions. Our data suggest that treatment with A-I might reduce short-term mortality in older patients with acute ischemic stroke. Randomized clinical trials should confirm this possible specific effect of A-I.