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Inhibidor recurrente de la enzima convertidora de angiotensina - angioedema asociado recurrente
N J Brown1, M Snowden, M R Griffin
1Department of Medicine, Vanderbilt University, Nashville, Tenn 37232-6602, USA. nancy.brown@mcmail.vanderbilt.edu
JAMA
|July 16, 1997
Resumen
El uso continuo de inhibidores de la ECA después del angioedema aumenta significativamente el riesgo de recurrencia. Los médicos a menudo atribuyen erróneamente el angioedema recurrente a otras causas, retrasando el diagnóstico y el tratamiento adecuado.
Área de la Ciencia:
- Farmacología cardiovascular farmacología cardiovascular
- Reacciones adversas al medicamento.
- Toxicología clínica toxicología clínica.
Sus antecedentes:
- Los inhibidores de la enzima de conversión de la angiotensina (ECA) están relacionados con el angioedema.
- El riesgo de angioedema recurrente con el uso continuado de inhibidores de la ECA no está bien establecido.
Objetivo del estudio:
- Para investigar el reconocimiento de la asociación ACE inhibidor-angioedema.
- Para caracterizar el angioedema en pacientes que continúan con la terapia con inhibidores de la ECA.
Principales métodos:
- Estudio de cohorte retrospectivo de los inscritos en Tennessee Medicaid (con edades ≥15 años).
- Análisis de pacientes con un primer episodio de angioedema durante el uso de inhibidores de la ECA (1986-1992).
- Seguimiento de los episodios recurrentes de angioedema hasta junio de 1993.
Principales resultados:
- Se identificaron 82 pacientes con angioedema inicial durante el uso de inhibidores de la ECA.
- La tasa de recurrencia fue de 8,5 por cada 100 pacientes-años.
- El uso continuado de inhibidores de la ECA mostró una tasa de recurrencia significativamente mayor (18.7/100 pacientes-año) frente a la interrupción (1.8/100 pacientes-año; P=.001).
- Los médicos con frecuencia atribuían las recurrencias a causas no relacionadas con los inhibidores de la ECA.
Conclusiones:
- El uso continuo de inhibidores de la ECA a pesar del angioedema conduce a un aumento sustancial de las tasas de recurrencia.
- Esta recurrencia se asocia con una morbilidad significativa.
- Un mejor reconocimiento del angioedema inducido por inhibidores de la ECA es crucial para la seguridad del paciente.
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