tetano
Editor, Senior Moderator
Circ Res. 2020 Apr 17. doi: 10.1161/CIRCRESAHA.120.317134. [Epub ahead of print]
Association of Inpatient Use of Angiotensin Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers with Mortality Among Patients With Hypertension Hospitalized With COVID-19.
Zhang P[SUP]1[/SUP], Zhu L[SUP]1[/SUP], Cai J[SUP]2[/SUP], Lei F[SUP]3[/SUP], Qin JJ[SUP]1[/SUP], Xie J[SUP]1[/SUP], Liu YM[SUP]1[/SUP], Zhao YC[SUP]4[/SUP], Huang X[SUP]1[/SUP], Lin L[SUP]3[/SUP], Xia M[SUP]3[/SUP], Chen MM[SUP]5[/SUP], Cheng X[SUP]1[/SUP], Zhang X[SUP]6[/SUP], Guo D[SUP]7[/SUP], Peng Y[SUP]8[/SUP], Ji YX[SUP]9[/SUP], Chen J[SUP]3[/SUP], She ZG[SUP]1[/SUP], Wang Y[SUP]10[/SUP], Xu Q[SUP]11[/SUP], Tan R[SUP]12[/SUP], Wang H[SUP]13[/SUP], Lin J[SUP]14[/SUP], Luo P[SUP]15[/SUP], Fu S[SUP]15[/SUP], Cai H[SUP]16[/SUP], Ye P[SUP]17[/SUP], Xiao B[SUP]18[/SUP], Mao W[SUP]19[/SUP], Liu L[SUP]20[/SUP], Yan Y[SUP]21[/SUP], Liu M[SUP]22[/SUP], Chen M[SUP]23[/SUP], Zhang XJ[SUP]1[/SUP], Wang X[SUP]24[/SUP], Touyz RM[SUP]25[/SUP], Xia J[SUP]26[/SUP], Zhang BH[SUP]27[/SUP], Huang X[SUP]28[/SUP], Yuan Y[SUP]7[/SUP], Rohit L[SUP]29[/SUP], Liu PP[SUP]30[/SUP], Li H[SUP]31[/SUP].
Author information
Abstract
Rationale: Use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) 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 COVID-19 patients with hypertension. 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 [IQR 55-68] years; 53.2% men) and 940 without using ACEI/ARB (non-ACEI/ARB group; median age 64 [IQR 57-69]; 53.5% men), who were admitted to nine hospitals in Hubei Province, China from December 31, 2019 to February 20, 2020. Unadjusted mortality rate was lower in the ACEI/ARB group versus the non-ACEI/ARB group (3.7% vs. 9.8%; P = 0.01). 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 HR, 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 HR, 0.37; 95% CI, 0.15-0.89; P = 0.03). Further subgroup propensity score-matched analysis indicated that, compared to use of other antihypertensive drugs, ACEI/ARB was also associated with decreased mortality (adjusted HR, 0.30; 95%CI, 0.12-0.70; P = 0.01) in COVID-19 patients with hypertension. Conclusions: Among hospitalized COVID-19 patients with hypertension, inpatient use of ACEI/ARB was associated with lower risk of all-cause mortality compared with ACEI/ARB non-users. 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.
KEYWORDS:
ACEI/ARB; COVID-19; Pneumonia; SARS-COV-2
PMID:32302265DOI:10.1161/CIRCRESAHA.120.317134
Association of Inpatient Use of Angiotensin Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers with Mortality Among Patients With Hypertension Hospitalized With COVID-19.
Zhang P[SUP]1[/SUP], Zhu L[SUP]1[/SUP], Cai J[SUP]2[/SUP], Lei F[SUP]3[/SUP], Qin JJ[SUP]1[/SUP], Xie J[SUP]1[/SUP], Liu YM[SUP]1[/SUP], Zhao YC[SUP]4[/SUP], Huang X[SUP]1[/SUP], Lin L[SUP]3[/SUP], Xia M[SUP]3[/SUP], Chen MM[SUP]5[/SUP], Cheng X[SUP]1[/SUP], Zhang X[SUP]6[/SUP], Guo D[SUP]7[/SUP], Peng Y[SUP]8[/SUP], Ji YX[SUP]9[/SUP], Chen J[SUP]3[/SUP], She ZG[SUP]1[/SUP], Wang Y[SUP]10[/SUP], Xu Q[SUP]11[/SUP], Tan R[SUP]12[/SUP], Wang H[SUP]13[/SUP], Lin J[SUP]14[/SUP], Luo P[SUP]15[/SUP], Fu S[SUP]15[/SUP], Cai H[SUP]16[/SUP], Ye P[SUP]17[/SUP], Xiao B[SUP]18[/SUP], Mao W[SUP]19[/SUP], Liu L[SUP]20[/SUP], Yan Y[SUP]21[/SUP], Liu M[SUP]22[/SUP], Chen M[SUP]23[/SUP], Zhang XJ[SUP]1[/SUP], Wang X[SUP]24[/SUP], Touyz RM[SUP]25[/SUP], Xia J[SUP]26[/SUP], Zhang BH[SUP]27[/SUP], Huang X[SUP]28[/SUP], Yuan Y[SUP]7[/SUP], Rohit L[SUP]29[/SUP], Liu PP[SUP]30[/SUP], Li H[SUP]31[/SUP].
Author information
Abstract
Rationale: Use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) 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 COVID-19 patients with hypertension. 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 [IQR 55-68] years; 53.2% men) and 940 without using ACEI/ARB (non-ACEI/ARB group; median age 64 [IQR 57-69]; 53.5% men), who were admitted to nine hospitals in Hubei Province, China from December 31, 2019 to February 20, 2020. Unadjusted mortality rate was lower in the ACEI/ARB group versus the non-ACEI/ARB group (3.7% vs. 9.8%; P = 0.01). 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 HR, 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 HR, 0.37; 95% CI, 0.15-0.89; P = 0.03). Further subgroup propensity score-matched analysis indicated that, compared to use of other antihypertensive drugs, ACEI/ARB was also associated with decreased mortality (adjusted HR, 0.30; 95%CI, 0.12-0.70; P = 0.01) in COVID-19 patients with hypertension. Conclusions: Among hospitalized COVID-19 patients with hypertension, inpatient use of ACEI/ARB was associated with lower risk of all-cause mortality compared with ACEI/ARB non-users. 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.
KEYWORDS:
ACEI/ARB; COVID-19; Pneumonia; SARS-COV-2
PMID:32302265DOI:10.1161/CIRCRESAHA.120.317134