Incidences associated with enalapril-induced angioedem in a public regional hospital, Limpopo Province (South Africa)

Abstract

Background: The study explored enalapril-induced angioedema reactions at Tshilidzini Regional Hospital (South Africa), from January 2017 to December 2019. The aim was to identify and describe incidences of enalapril- induced angioedema in a public regional hospital, over a three-year period. Materials and Methods A retrospective record review was undertaken at Tshilidzini Hospital. Data were collected from medical files of patients who had experienced enalapril-induced angioedema, between January 2017 to December 2019. Cases were retrieved using the pharmacovigilance ADR database records. Demographic information, medical history, clinical presentations, therapeutic management and outcomes were collected and consolidated on a data collection tool. A Microsoft Excel spreadsheet was used to record the information which was then interpreted utilizing the Statistical Package for Social Sciences (SPSS) version 29. Ethical clearance was acquired from the University of the Witwatersrand Human Research Ethics Committee (Medical). Results: Forty cases (37.3%) of enalapril-induced angioedema were included out of a total of hundred and seven cases reviewed from the Pharmacovigilance ADR database records. The results indicated that demographic details - gender, age and race - affected the incidence of enalapril-induced angioedema. Out of the forty cases, most were female (95%) and between the ages of 50-59 (25%) and 70-79 (25%). Majority of the participants presented with swollen lips (34%) and tongue (24%) as clinical presentations of enalapril- induced angioedema. All participants were counselled and they discontinued enalapril after the incident. Hospitalization occurred in 15% of the participants and death occurred in 5% of the participants. Conclusion: Amongst the cases reviewed, swelling of the lips and tongue was reported to be the most common clinical presentation of enalapril-induced angioedema. The study findings suggest a need for awareness among all healthcare professionals, so that they could identify and treat enalapril-induced angioedema as well as report all incidences. ACE-induced angioedema may be occurring more regularly but may not be known due to misdiagnosis and underreporting by healthcare professionals. This shows that healthcare professionals must constantly be conscious about the significance of reporting enalapril-induced angioedema to improve patients’ safety and treatment outcomes. More reporting of incidences and further research is required for healthcare professionals to become knowledgeable about this life-threatening condition.