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Chronic use of renin–angiotensin–aldosterone inhibitors in hypertensive COVID-19 patients: Results from a Spanish registry and meta-analysis

BACKGROUND: Hypertension is a prevalent condition among SARS-CoV-2 infected patients. Whether renin–angiotensin–aldosterone system (RAAS) inhibitors are beneficial or harmful is controversial. METHODS: We have performed a national retrospective, nonexperimental comparative study from two tertiary ho...

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Detalles Bibliográficos
Autores principales: Aparisi, Álvaro, Catalá, Pablo, Amat-Santos, Ignacio J., Marcos-Mangas, Marta, López-Otero, Diego, Veras, Carlos, López-Pais, Javier, Cabezón-Villalba, Gonzalo, Cacho Antonio, Carla Eugenia, Candela, Jordi, Antúnez-Muiños, Pablo, Gil, José Francisco, González Ferrero, Teba, Rojas, Gino, Pérez-Poza, Marta, Uribarri, Aitor, Otero-García, Oscar, García-Granja, Pablo Elpidio, Jiménez Ramos, Víctor, Revilla, Ana, Dueñas, Carlos, Gómez, Itzíar, González-Juanatey, José Ramón, San Román, J. Alberto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier España, S.L.U. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101788/
https://www.ncbi.nlm.nih.gov/pubmed/34088524
http://dx.doi.org/10.1016/j.medcli.2021.04.005
Descripción
Sumario:BACKGROUND: Hypertension is a prevalent condition among SARS-CoV-2 infected patients. Whether renin–angiotensin–aldosterone system (RAAS) inhibitors are beneficial or harmful is controversial. METHODS: We have performed a national retrospective, nonexperimental comparative study from two tertiary hospitals to evaluate the impact of chronic use of RAAS inhibitors in hypertensive COVID-19 patients. A meta-analysis was performed to strengthen our findings. RESULTS: Of 849 patients, 422 (49.7%) patients were hypertensive and 310 (73.5%) were taking RAAS inhibitors at baseline. Hypertensive patients were older, had more comorbidities, and a greater incidence of respiratory failure (−0.151 [95% CI −0.218, −0.084]). Overall mortality in hypertensive patients was 28.4%, but smaller among those with prescribed RAAS inhibitors before (−0.167 [95% CI −0.220, −0.114]) and during hospitalization (0.090 [−0.008,0.188]). Similar findings were observed after two propensity score matches that evaluated the benefit of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers among hypertensive patients. Multivariate logistic regression analysis of hypertensive patients found that age, diabetes mellitus, C-reactive protein, and renal failure were independently associated with all-cause mortality. On the contrary, ACEIs decreased the risk of death (OR 0.444 [95% CI 0.224–0.881]). Meta-analysis suggested a protective benefit of RAAS inhibitors (OR 0.6 [95% CI 0.42–0.8]) among hypertensive COVID-19. CONCLUSION: Our data suggest that RAAS inhibitors may play a protective role in hypertensive COVID-19 patients. This finding was supported by a meta-analysis of the current evidence. Maintaining these medications during hospital stay may not negatively affect COVID-19 outcomes.