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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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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
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author 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
author_facet 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
author_sort Aparisi, Álvaro
collection PubMed
description 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.
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spelling pubmed-81017882021-05-07 Chronic use of renin–angiotensin–aldosterone inhibitors in hypertensive COVID-19 patients: Results from a Spanish registry and meta-analysis 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 Med Clin (Barc) Original Article 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. Elsevier España, S.L.U. 2022-04-08 2021-05-06 /pmc/articles/PMC8101788/ /pubmed/34088524 http://dx.doi.org/10.1016/j.medcli.2021.04.005 Text en © 2021 Elsevier España, S.L.U. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Original Article
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
Chronic use of renin–angiotensin–aldosterone inhibitors in hypertensive COVID-19 patients: Results from a Spanish registry and meta-analysis
title Chronic use of renin–angiotensin–aldosterone inhibitors in hypertensive COVID-19 patients: Results from a Spanish registry and meta-analysis
title_full Chronic use of renin–angiotensin–aldosterone inhibitors in hypertensive COVID-19 patients: Results from a Spanish registry and meta-analysis
title_fullStr Chronic use of renin–angiotensin–aldosterone inhibitors in hypertensive COVID-19 patients: Results from a Spanish registry and meta-analysis
title_full_unstemmed Chronic use of renin–angiotensin–aldosterone inhibitors in hypertensive COVID-19 patients: Results from a Spanish registry and meta-analysis
title_short Chronic use of renin–angiotensin–aldosterone inhibitors in hypertensive COVID-19 patients: Results from a Spanish registry and meta-analysis
title_sort chronic use of renin–angiotensin–aldosterone inhibitors in hypertensive covid-19 patients: results from a spanish registry and meta-analysis
topic Original Article
url 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
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