Can Pressure Ulcers Be Prevented with Use of Angiotensin Receptor Blockers(arb)?

Introduction: Pressure ulcers are difficult to avoid even with aggressive prevention strategy, and their impact includes many cases with hypertension (HTN) and hyperlipidemia (HLD). A change in cholesterol as a precursor to prostaglandins may affect aldosterone, which is critical focus of HTN management. Aspirin can affect prostaglandins as well. A study was done to better categorize the relationship in wound patients with hyperlipemia (HLD), HTN, and on aspirin (ASA), as well as angiotensin converting enzyme inhibitors (ACEi) and ARBs, and whether it correlated to the presence of pressure ulcers.

Methods: A retrospective review (2016–2018) of outpatient wound care patients who were evaluated by block anova, descriptive, box plots, and CHI analysis. A cohort of 104 cases, similar gender, BMI, and age were considered. All were on an aspirin (ASA) and HLD treatment program. A review of their race, diabetes status, HTN medications, and mean blood pressure (MAP) was done.

Results: In this cohort, women had a higher incidence of pressure ulcers (n=14, 93%). Of the whole cohort, more than half (n=55) were being treated with ACEi or ARB. ACEi and non-ACEi/ARB groups had the higher incidence pressure ulcers (19%, and 20%, respectively). Of note, only 2.9% of the ARB group incurred pressure ulcers (chi square significant, p=0.025).  BMI had no relation to the presence of pressure ulcers, and MAP of ACEi and ARB cases were similar.

Conclusion: Pressure ulcer patients at outpatient wound centers may be categorized at-risk if female and on a non-ARB HTN treatment plan. Consideration of addition or substitution with ARBs may be of benefit in pressure ulcer prevention.