Dysphagia was assessed by technetium tin colloid scanning. The technetium tin colloid was administered through a nasal catheter during sleep, and in the morning the lungs were scanned for evidence of technetium tin colloid. There was a decrease of technetium tin colloid in the lungs in 62% of patients treated with an ACE inhibitor. Of those patients treated with ACE inhibitors (n = 127), pneumonia developed in 7% of patients compared to 18% of patients who had been treated with other antihypertensive agents (relative risk, 2.65; 95% CI, 1.3 to 5.3; p = 0.007). In another study from this same research group, the rate of pneumonia was shown in elderly hypertensive patients (n = 576) who had been treated with an ACE inhibitor and compared to those who had been treated with a calcium channel blocker, and pneumonia rates of 3.3% and 8.9%, respectively, were found. In a later study of elderly patients with stroke and dysphagia (n = 53), which also used the technetium tin colloid-scanning technique, patients were randomized to receive either ACE inhibitors or calcium channel blockers. canadian family pharmacy online
The amount of technetium tin colloid found in the lungs was reduced in 71% of patients (23 of 32 patients) in the ACE inhibitor group, while none of the patients in the calcium channel blocker group showed improvement of dysphagia. These studies assume that aspiration during sleep is the cause of pneumonia without considering other factors. It cannot be assumed that the nocturnal aspiration of secretions correlates to the aspiration of food and liquids. A study to correlate nocturnal aspiration with aspiration during VSE or FEES needs to be performed before nocturnal aspiration can be equated to oral-pharyngeal dysphagia; therefore, no recommendation can be made for the use of ACE inhibitors. These patients should be categorized as dysphagic on the basis of VSE or FEES findings in order to determine the effectiveness of ACE inhibitors in preventing oral pharyngeal aspiration.