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Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and COVID-19-related outcomes: A patient-level analysis of the PCORnet blood pressure control lab

SARS-CoV-2 accesses host cells via angiotensin-converting enzyme-2, which is also affected by commonly used angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), raising concerns that ACEI or ARB exposure may portend differential COVID-19 outcomes. In parallel co...

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Autores principales: Smith, Steven M., Desai, Raj A., Walsh, Marta G., Nilles, Ester Kim, Shaw, Katie, Smith, Myra, Chamberlain, Alanna M., Derington, Catherine G., Bress, Adam P., Chuang, Cynthia H., Ford, Daniel E., Taylor, Bradley W., Chandaka, Sravani, Patel, Lav Parshottambhai, McClay, James, Priest, Elisa, Fuloria, Jyotsna, Doshi, Kruti, Ahmad, Faraz S., Viera, Anthony J., Faulkner, Madelaine, O'Brien, Emily C., Pletcher, Mark J., Cooper-DeHoff, Rhonda M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Author(s). Published by Elsevier Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8889730/
https://www.ncbi.nlm.nih.gov/pubmed/35252907
http://dx.doi.org/10.1016/j.ahjo.2022.100112
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author Smith, Steven M.
Desai, Raj A.
Walsh, Marta G.
Nilles, Ester Kim
Shaw, Katie
Smith, Myra
Chamberlain, Alanna M.
Derington, Catherine G.
Bress, Adam P.
Chuang, Cynthia H.
Ford, Daniel E.
Taylor, Bradley W.
Chandaka, Sravani
Patel, Lav Parshottambhai
McClay, James
Priest, Elisa
Fuloria, Jyotsna
Doshi, Kruti
Ahmad, Faraz S.
Viera, Anthony J.
Faulkner, Madelaine
O'Brien, Emily C.
Pletcher, Mark J.
Cooper-DeHoff, Rhonda M.
author_facet Smith, Steven M.
Desai, Raj A.
Walsh, Marta G.
Nilles, Ester Kim
Shaw, Katie
Smith, Myra
Chamberlain, Alanna M.
Derington, Catherine G.
Bress, Adam P.
Chuang, Cynthia H.
Ford, Daniel E.
Taylor, Bradley W.
Chandaka, Sravani
Patel, Lav Parshottambhai
McClay, James
Priest, Elisa
Fuloria, Jyotsna
Doshi, Kruti
Ahmad, Faraz S.
Viera, Anthony J.
Faulkner, Madelaine
O'Brien, Emily C.
Pletcher, Mark J.
Cooper-DeHoff, Rhonda M.
author_sort Smith, Steven M.
collection PubMed
description SARS-CoV-2 accesses host cells via angiotensin-converting enzyme-2, which is also affected by commonly used angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), raising concerns that ACEI or ARB exposure may portend differential COVID-19 outcomes. In parallel cohort studies of outpatient and inpatient COVID-19-diagnosed adults with hypertension, we assessed associations between antihypertensive exposure (ACEI/ARB vs. non-ACEI/ARB antihypertensives, as well as between ACEI- vs. ARB) at the time of COVID-19 diagnosis, using electronic health record data from PCORnet health systems. The primary outcomes were all-cause hospitalization or death (outpatient cohort) or all-cause death (inpatient), analyzed via Cox regression weighted by inverse probability of treatment weights. From February 2020 through December 9, 2020, 11,246 patients (3477 person-years) and 2200 patients (777 person-years) were included from 17 health systems in outpatient and inpatient cohorts, respectively. There were 1015 all-cause hospitalization or deaths in the outpatient cohort (incidence, 29.2 events per 100 person-years), with no significant difference by ACEI/ARB use (adjusted HR 1.01; 95% CI 0.88, 1.15). In the inpatient cohort, there were 218 all-cause deaths (incidence, 28.1 per 100 person-years) and ACEI/ARB exposure was associated with reduced death (adjusted HR, 0.76; 95% CI, 0.57, 0.99). ACEI, versus ARB exposure, was associated with higher risk of hospitalization in the outpatient cohort, but no difference in all-cause death in either cohort. There was no evidence of effect modification across pre-specified baseline characteristics. Our results suggest ACEI and ARB exposure have no detrimental effect on hospitalizations and may reduce death among hypertensive patients diagnosed with COVID-19.
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spelling pubmed-88897302022-03-02 Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and COVID-19-related outcomes: A patient-level analysis of the PCORnet blood pressure control lab Smith, Steven M. Desai, Raj A. Walsh, Marta G. Nilles, Ester Kim Shaw, Katie Smith, Myra Chamberlain, Alanna M. Derington, Catherine G. Bress, Adam P. Chuang, Cynthia H. Ford, Daniel E. Taylor, Bradley W. Chandaka, Sravani Patel, Lav Parshottambhai McClay, James Priest, Elisa Fuloria, Jyotsna Doshi, Kruti Ahmad, Faraz S. Viera, Anthony J. Faulkner, Madelaine O'Brien, Emily C. Pletcher, Mark J. Cooper-DeHoff, Rhonda M. Am Heart J Plus Research Paper SARS-CoV-2 accesses host cells via angiotensin-converting enzyme-2, which is also affected by commonly used angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), raising concerns that ACEI or ARB exposure may portend differential COVID-19 outcomes. In parallel cohort studies of outpatient and inpatient COVID-19-diagnosed adults with hypertension, we assessed associations between antihypertensive exposure (ACEI/ARB vs. non-ACEI/ARB antihypertensives, as well as between ACEI- vs. ARB) at the time of COVID-19 diagnosis, using electronic health record data from PCORnet health systems. The primary outcomes were all-cause hospitalization or death (outpatient cohort) or all-cause death (inpatient), analyzed via Cox regression weighted by inverse probability of treatment weights. From February 2020 through December 9, 2020, 11,246 patients (3477 person-years) and 2200 patients (777 person-years) were included from 17 health systems in outpatient and inpatient cohorts, respectively. There were 1015 all-cause hospitalization or deaths in the outpatient cohort (incidence, 29.2 events per 100 person-years), with no significant difference by ACEI/ARB use (adjusted HR 1.01; 95% CI 0.88, 1.15). In the inpatient cohort, there were 218 all-cause deaths (incidence, 28.1 per 100 person-years) and ACEI/ARB exposure was associated with reduced death (adjusted HR, 0.76; 95% CI, 0.57, 0.99). ACEI, versus ARB exposure, was associated with higher risk of hospitalization in the outpatient cohort, but no difference in all-cause death in either cohort. There was no evidence of effect modification across pre-specified baseline characteristics. Our results suggest ACEI and ARB exposure have no detrimental effect on hospitalizations and may reduce death among hypertensive patients diagnosed with COVID-19. The Author(s). Published by Elsevier Inc. 2022-01 2022-03-02 /pmc/articles/PMC8889730/ /pubmed/35252907 http://dx.doi.org/10.1016/j.ahjo.2022.100112 Text en © 2022 The Author(s) 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 Research Paper
Smith, Steven M.
Desai, Raj A.
Walsh, Marta G.
Nilles, Ester Kim
Shaw, Katie
Smith, Myra
Chamberlain, Alanna M.
Derington, Catherine G.
Bress, Adam P.
Chuang, Cynthia H.
Ford, Daniel E.
Taylor, Bradley W.
Chandaka, Sravani
Patel, Lav Parshottambhai
McClay, James
Priest, Elisa
Fuloria, Jyotsna
Doshi, Kruti
Ahmad, Faraz S.
Viera, Anthony J.
Faulkner, Madelaine
O'Brien, Emily C.
Pletcher, Mark J.
Cooper-DeHoff, Rhonda M.
Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and COVID-19-related outcomes: A patient-level analysis of the PCORnet blood pressure control lab
title Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and COVID-19-related outcomes: A patient-level analysis of the PCORnet blood pressure control lab
title_full Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and COVID-19-related outcomes: A patient-level analysis of the PCORnet blood pressure control lab
title_fullStr Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and COVID-19-related outcomes: A patient-level analysis of the PCORnet blood pressure control lab
title_full_unstemmed Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and COVID-19-related outcomes: A patient-level analysis of the PCORnet blood pressure control lab
title_short Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and COVID-19-related outcomes: A patient-level analysis of the PCORnet blood pressure control lab
title_sort angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and covid-19-related outcomes: a patient-level analysis of the pcornet blood pressure control lab
topic Research Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8889730/
https://www.ncbi.nlm.nih.gov/pubmed/35252907
http://dx.doi.org/10.1016/j.ahjo.2022.100112
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