Association of Inpatient Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Mortality Among Patients With Hypertension Hospitalized With COVID-19

Use of ACEIs (angiotensin-converting enzyme inhibitors) and ARBs (angiotensin II receptor blockers) is a major concern for clinicians treating coronavirus disease 2019 (COVID-19) in patients with hypertension. OBJECTIVE: To determine the association between in-hospital use of ACEI/ARB and all-cause...

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Detalles Bibliográficos
Autores principales: Zhang, Peng, Zhu, Lihua, Cai, Jingjing, Lei, Fang, Qin, Juan-Juan, Xie, Jing, Liu, Ye-Mao, Zhao, Yan-Ci, Huang, Xuewei, Lin, Lijin, Xia, Meng, Chen, Ming-Ming, Cheng, Xu, Zhang, Xiao, Guo, Deliang, Peng, Yuanyuan, Ji, Yan-Xiao, Chen, Jing, She, Zhi-Gang, Wang, Yibin, Xu, Qingbo, Tan, Renfu, Wang, Haitao, Lin, Jun, Luo, Pengcheng, Fu, Shouzhi, Cai, Hongbin, Ye, Ping, Xiao, Bing, Mao, Weiming, Liu, Liming, Yan, Youqin, Liu, Mingyu, Chen, Manhua, Zhang, Xiao-Jing, Wang, Xinghuan, Touyz, Rhian M., Xia, Jiahong, Zhang, Bing-Hong, Huang, Xiaodong, Yuan, Yufeng, Loomba, Rohit, Liu, Peter P., Li, Hongliang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2020
Materias:
Original Research
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265882/
https://www.ncbi.nlm.nih.gov/pubmed/32302265
http://dx.doi.org/10.1161/CIRCRESAHA.120.317134
Descripción
Sumario:Use of ACEIs (angiotensin-converting enzyme inhibitors) and ARBs (angiotensin II receptor blockers) is a major concern for clinicians treating coronavirus disease 2019 (COVID-19) in patients with hypertension. OBJECTIVE: To determine the association between in-hospital use of ACEI/ARB and all-cause mortality in patients with hypertension and hospitalized due to COVID-19. METHODS AND RESULTS: This retrospective, multi-center study included 1128 adult patients with hypertension diagnosed with COVID-19, including 188 taking ACEI/ARB (ACEI/ARB group; median age 64 [interquartile range, 55–68] years; 53.2% men) and 940 without using ACEI/ARB (non-ACEI/ARB group; median age 64 [interquartile range 57–69]; 53.5% men), who were admitted to 9 hospitals in Hubei Province, China from December 31, 2019 to February 20, 2020. In mixed-effect Cox model treating site as a random effect, after adjusting for age, gender, comorbidities, and in-hospital medications, the detected risk for all-cause mortality was lower in the ACEI/ARB group versus the non-ACEI/ARB group (adjusted hazard ratio, 0.42 [95% CI, 0.19–0.92]; P=0.03). In a propensity score-matched analysis followed by adjusting imbalanced variables in mixed-effect Cox model, the results consistently demonstrated lower risk of COVID-19 mortality in patients who received ACEI/ARB versus those who did not receive ACEI/ARB (adjusted hazard ratio, 0.37 [95% CI, 0.15–0.89]; P=0.03). Further subgroup propensity score-matched analysis indicated that, compared with use of other antihypertensive drugs, ACEI/ARB was also associated with decreased mortality (adjusted hazard ratio, 0.30 [95% CI, 0.12–0.70]; P=0.01) in patients with COVID-19 and coexisting hypertension. CONCLUSIONS: Among hospitalized patients with COVID-19 and coexisting hypertension, inpatient use of ACEI/ARB was associated with lower risk of all-cause mortality compared with ACEI/ARB nonusers. While study interpretation needs to consider the potential for residual confounders, it is unlikely that in-hospital use of ACEI/ARB was associated with an increased mortality risk.

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