Epidemiology and Incidence of ACE Inhibitor Angioedema Utilizing a Large Electronic Health Record
Saturday, March 5, 2016
South Exhibit Hall H (Convention Center)
Aleena Banerji, MD, Kimberly G Blumenthal, M.D., Kenneth H Lai, MA, Li Zhou, MD, PhD
Rationale:  Angiotensin-converting enzyme inhibitors (ACEI) are the leading cause of drug-induced angioedema in the United States. Most epidemiologic ACEI angioedema data are from large multi-center clinical trials. Our objective was to identify the incidence and risk factors of ACEI angioedema using a large integrated electronic health record (EHR).

Methods:  We conducted a retrospective cohort study of all ACEI prescriptions over nine years at a large academic center. We determined frequency, timing, and risk factors for ACEI angioedema considering five years after prescription. All data were derived from EHR sources, with angioedema defined by EHR reactions of angioedema, swelling, edema, or lip, face, tongue, throat or mouth swelling.

Results:  There were 134,945 patients prescribed ACEI between January 1, 2000 to September 30, 2008; 0.66% (n=888) developed angioedema during the subsequent five years. Age and gender were similar but patients with hypertension (0.75% vs. 0.42%, p<0.0001) and NSAID allergy (1.10% vs. 0.64%, p<0.0001) were more likely to develop ACEI angioedema than those without. We identified a 0.07% incidence of ACEI angioedema within one month and 0.23% incidence during the first 12 months. Incidence of angioedema was relatively constant over the subsequent four years (0.10%-0.12%). Lisinopril (87.1%), enalapril (4.3%), and benazepril (3.0%) were the most common causative ACEI.

Conclusions:  The incidence of ACEI angioedema within a large EHR is consistent with large clinical trial data. While angioedema risk is twice as high in the first year, we observed a persistent and relatively constant risk yearly for the next four years. Risk factors need to be studied further.