Relationship between in-hospital angiotensin converting enzyme inhibitors and Angiotensin receptor blockers administration and delirium in the cardiac ICU

ABSTRACT

Objectives

Delirium may be associated with neuroinflammation and reduced blood-brain barrier (BBB) stability. ACE Inhibitors (ACEIs) and Angiotensin Receptor Blockers (ARBs) reduce neuroinflammation and stabilize the BBB, thus slowing the progression of memory loss in patients with dementia. This study evaluated the effect of these medications on delirium prevalence

Methods

This was a retrospective study of data from all patients admitted to a Cardiac ICU between 1 January 2020-31 December 2020. The presence of delirium was determined based on the International Classification of Diseases (ICD) 10 codes and nurse delirium screening.

Results

Of the 1684 unique patients, almost half developed delirium. Delirious patients who did not receive either ACEI or ARB had higher odds (odds ratio [OR] 5.88, 95% CI 3.7–9.09, P < .001) of in-hospital death and experienced significantly shorter ICU lengths of stay (LOS) (P = .01). There was no significant effect of medication exposure on the time to delirium onset.

Conclusions

While ACEIs and ARBs have been shown to slow the progression of memory loss for patients with Alzheimer’s disease, we did not observe a difference in time to delirium onset.

KEYWORDS:

• Antihypertensives
• ACE inhibitor
• Angiotensin receptor blocker
• cardiac intensive care unit
• delirium

Acknowledgments

We thank Dr. Babar Khan for his insight during the data collection and analysis.

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Malissa Mulkey drafted and revised the manuscript. Paloma Hauser performed the statistical analysis, contributed to the draft and revised the manuscript. Julia Aucoin revised and edited the manuscript.

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/21548331.2023.2232501.

Additional information

Funding

This paper was supported by a Geriatric Advanced Practice Nurse Association Research Grant and the National Institute of Nursing Research (grant number: NRSA T32 NR018407)