Commonly used BP drugs associated with increased suicide risk: JAMA

Canada: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are commonly used drugs for the management of hypertension, chronic kidney disease and heart failure. These medications lower blood pressure by modulating the renin-angiotensin-aldosterone system in different ways.

The renin-angiotensin system has been implicated for the treatment of mood disorders. Now, a recent study has found the use of Angiotensin receptor blockers to be associated with increased suicide risk compared to ACEIs use.

Results of the study, published in the journal JAMA Psychiatry, lay stress on the preferential use of ACEIs over ARBs whenever possible, particularly in elderly patients with severe mental health illness.

ACEIs and ARBs are among the most commonly used medications implicated in mood disorders, yet their effects on mental health outcomes, particularly suicide, are poorly understood.

Muhammad Mamdani, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada, and colleagues examined the association between suicide and exposure to ACEIs and ARBs. Because of differences in their mode of action, it was speculated that ARBs would be associated with a higher risk of suicide than ACEIs.

The study, involving people aged 66 years and older, used administrative claims databases in Ontario, Canada, from January 1, 1995, to December 31, 2015. Data analysis was performed from January to April 2019. Cases were individuals who died by suicide within 100 days of receiving an ACEI or ARB. The date of death served as the index date. For each case, 4 controls were identified and matched by age (within
1 year), sex, and presence of hypertension and diabetes. All individuals received an ACEI or ARB within 100 days before the index date.

Nine hundred sixty-four cases were matched to 3856 controls. The median (interquartile range) age of cases and controls was 76 (70-82) years. Most cases (768 [79.7%]) and controls (3068 [79.6%]) were men. Among cases, 260 (26.0%) were exposed to ARBs, and 704 (18.4%) were exposed to ACEIs. Among controls, 741 (74.0%) were exposed to ARBs, and 3115 (81.6%) were exposed to ACEIs.

Key findings include:

• Compared with ACEI exposure, ARB exposure was associated with a higher risk of death by suicide.


• The findings were consistent in a sensitivity analysis excluding individuals with a history of self-harm.

"Our findings suggest a possible increased risk of suicide associated with the use of ARBs compared with ACEIs among adults aged 66 years and older. Given their high prevalence of use, the severity of the outcome, and the similar efficacy of these drug classes in treating the same conditions, clinicians may opt for preferential use of ACEIs over ARBs where possible," concluded the authors.

More Information: "Association Between Angiotensin-Converting Enzyme Inhibitors, Angiotensin Receptor Blockers, and Suicide" published in the journal JAMA Psychiatry.

DOI:10.1001/jamanetworkopen.2019.13304

Journal Information: JAMA Psychiatry