Association of renin-angiotensin system blockers with COVID-19 diagnosis and prognosis in patients with hypertension: a population-based study.
Association of renin-angiotensin system blockers with COVID-19 diagnosis and prognosis in patients with hypertension: a population-based study.
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DOI：
10.1093/ckj/sfab161
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发表时间：
2022-01
影响因子：
4.6
通讯作者：
Vall d’Hebron COVID-19 Working Group
中科院分区：
文献类型：
--
作者：
Soler MJ;Ribera A;Marsal JR;Mendez AB;Andres M;Azancot MA;Oristrell G;Méndez-Boo L;Cohen J;Barrabés JA;Ferreira-González I;Vall d’Hebron COVID-19 Working Group
血管紧张素转换酶抑制剂（ACEis）或血管紧张素受体阻滞剂（ARB）阻断肾素-血管紧张素系统（RAS）对2019冠状病毒病（COVID-19）易感性、死亡率和严重程度的影响描述不充分。我们在一个基于大人群的高血压患者（HTN）队列中研究了RAS阻断与COVID-19诊断和预后之间的关系。这是一项使用区域健康记录的队列研究。我们从加泰罗尼亚（西班牙）主要医疗服务提供者的87个医疗保健参考区域确定了所有年龄在18-95岁之间的个体，并从初级保健记录中确定了HTN病史。数据与2020年3月1日至2020年8月14日的COVID-19检测结果、医院、药房及死亡率记录挂钩。我们将RAS阻滞剂暴露定义为在COVID-19诊断前3个月或2020年3月1日期间分配ACEi/ARB。主要结局为：住院COVID-19患者的COVID-19感染和严重进展（需要侵入性呼吸支持或死亡的复合）。对于两种结局和每种关注的暴露（RAS阻断、ACEi或ARB），我们估计了年龄、性别、医疗保健领域和倾向评分匹配样本的相关性。从1365215名居民的队列中，我们确定了305972例有HTN病史的患者。HTN患者近期使用ACEi/ARB与COVID-19诊断的6个月累积发生率较低相关{3.78% [95%置信区间（CI）3.69-3.86%] vs 4.53%（95% CI 4.40-4.65%）; P < 0.001}。在12344例COVID-19感染患者中，使用ACEi/ARB与需要有创呼吸支持的住院或死亡风险升高无关[OR = 0.91（0.71-1.15）; P = 0.426]。HTN患者的RAS阻断与COVID-19感染风险升高或疾病进展恶化无关。
The effect of renin–angiotensin system (RAS) blockade either by angiotensin-converting enzyme inhibitors (ACEis) or angiotensin-receptor blockers (ARBs) on coronavirus disease 2019 (COVID-19) susceptibility, mortality and severity is inadequately described. We examined the association between RAS blockade and COVID-19 diagnosis and prognosis in a large population-based cohort of patients with hypertension (HTN). This is a cohort study using regional health records. We identified all individuals aged 18–95 years from 87 healthcare reference areas of the main health provider in Catalonia (Spain), with a history of HTN from primary care records. Data were linked to COVID-19 test results, hospital, pharmacy and mortality records from 1 March 2020 to 14 August 2020. We defined exposure to RAS blockers as the dispensation of ACEi/ARBs during the 3 months before COVID-19 diagnosis or 1 March 2020. Primary outcomes were: COVID-19 infection and severe progression in hospitalized patients with COVID-19 (the composite of need for invasive respiratory support or death). For both outcomes and for each exposure of interest (RAS blockade, ACEi or ARB) we estimated associations in age-, sex-, healthcare area- and propensity score-matched samples. From a cohort of 1 365 215 inhabitants we identified 305 972 patients with HTN history. Recent use of ACEi/ARBs in patients with HTN was associated with a lower 6-month cumulative incidence of COVID-19 diagnosis {3.78% [95% confidence interval (CI) 3.69–3.86%] versus 4.53% (95% CI 4.40–4.65%); P < 0.001}. In the 12 344 patients with COVID-19 infection, the use of ACEi/ARBs was not associated with a higher risk of hospitalization with need for invasive respiratory support or death [OR = 0.91 (0.71–1.15); P = 0.426]. RAS blockade in patients with HTN is not associated with higher risk of COVID-19 infection or with a worse progression of the disease.
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