Risk of severe COVID-19 disease with ACE inhibitors and angiotensin receptor blockers: cohort study including 8.3 million people.
Risk of severe COVID-19 disease with ACE inhibitors and angiotensin receptor blockers: cohort study including 8.3 million people.
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DOI：
10.1136/heartjnl-2020-317393
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发表时间：
2020-10
期刊：
影响因子：
--
通讯作者：
Watkinson PJ
中科院分区：
文献类型：
--
作者：
Hippisley-Cox J;Young D;Coupland C;Channon KM;Tan PS;Harrison DA;Rowan K;Aveyard P;Pavord ID;Watkinson PJ
血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂与新冠肺炎病的相关性尚不确定。我们研究了患者服用这些药物是否改变了感染严重新冠肺炎病和接受相关重症监护病房(ICU)入院的风险。这是一项前瞻性队列研究，使用了从英格兰1205个一般实践中常规收集的数据，共有828万名年龄在20-99岁的 参与者。我们使用COX比例风险模型得出了根据社会人口学因素、同时用药和地理区域调整的ACE抑制剂和ARB药物暴露的调整后的HR。主要结果是：(A)新冠肺炎逆转录-聚合酶链式反应诊断为新冠肺炎病，(B)新冠肺炎病需要ICU治疗。在19ICU486例新冠肺炎患者中，有1286例接受了 治疗。血管紧张素转换酶抑制剂显著降低新冠肺炎病的风险(调整后的HR为0.71，95% CI为0.67至0.74)，但在调整多种混杂因素后，没有增加ICU护理的风险(调整后的HR为0.89，95% CI为0.75至1.06)。新冠肺炎病和ICU治疗ARBS的调整后比分别为0.63(95%CI 0.59~0.67)和1.02(95%CI 0.83~1.25)。种族与血管紧张素转换酶抑制剂和血管紧张素转换酶抑制剂以及新冠肺炎ARB之间存在显著的交互作用。与血管紧张素转换酶抑制剂相关的新冠肺炎病的风险在加勒比(调整后的HR为1.05，95%CI为0.87至1.28)和非洲黑人(调整后的HR为1.31，95%CI为1.08至1.59)组比白人组(调整后的HR为0.66，95% CI为0.63至0.70)更高。与白人组(调整后HR 0.56，95% CI 0.52至0.62)相比，非洲黑人(调整后的HR为1.24，95% CI为0.99至1.58)患新冠肺炎ARBS的风险更高。在调整了广泛的变量后，ACE抑制剂和ARB与降低新冠肺炎病的风险有关。无论是血管紧张素转换酶抑制剂还是ARB，都不会显著增加接受ICU治疗的风险。不同种族之间的差异增加了血管紧张素转换酶抑制剂/ARBS对新冠肺炎疾病易感性和严重程度的种族特异性影响的可能性，值得进一步研究。
There is uncertainty about the associations of angiotensive enzyme (ACE) inhibitor and angiotensin receptor blocker (ARB) drugs with COVID-19 disease. We studied whether patients prescribed these drugs had altered risks of contracting severe COVID-19 disease and receiving associated intensive care unit (ICU) admission. This was a prospective cohort study using routinely collected data from 1205 general practices in England with 8.28 million participants aged 20–99 years. We used Cox proportional hazards models to derive adjusted HRs for exposure to ACE inhibitor and ARB drugs adjusted for sociodemographic factors, concurrent medications and geographical region. The primary outcomes were: (a) COVID-19 RT-PCR diagnosed disease and (b) COVID-19 disease resulting in ICU care. Of 19 486 patients who had COVID-19 disease, 1286 received ICU care. ACE inhibitors were associated with a significantly reduced risk of COVID-19 disease (adjusted HR 0.71, 95% CI 0.67 to 0.74) but no increased risk of ICU care (adjusted HR 0.89, 95% CI 0.75 to 1.06) after adjusting for a wide range of confounders. Adjusted HRs for ARBs were 0.63 (95% CI 0.59 to 0.67) for COVID-19 disease and 1.02 (95% CI 0.83 to 1.25) for ICU care. There were significant interactions between ethnicity and ACE inhibitors and ARBs for COVID-19 disease. The risk of COVID-19 disease associated with ACE inhibitors was higher in Caribbean (adjusted HR 1.05, 95% CI 0.87 to 1.28) and Black African (adjusted HR 1.31, 95% CI 1.08 to 1.59) groups than the white group (adjusted HR 0.66, 95% CI 0.63 to 0.70). A higher risk of COVID-19 with ARBs was seen for Black African (adjusted HR 1.24, 95% CI 0.99 to 1.58) than the white (adjusted HR 0.56, 95% CI 0.52 to 0.62) group. ACE inhibitors and ARBs are associated with reduced risks of COVID-19 disease after adjusting for a wide range of variables. Neither ACE inhibitors nor ARBs are associated with significantly increased risks of receiving ICU care. Variations between different ethnic groups raise the possibility of ethnic-specific effects of ACE inhibitors/ARBs on COVID-19 disease susceptibility and severity which deserves further study.
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DOI：
10.15585/mmwr.mm6915e3
发表时间：
2020-04-17
期刊：
MMWR. Morbidity and mortality weekly report
影响因子：
--
作者：
Garg S;Kim L;Whitaker M;O'Halloran A;Cummings C;Holstein R;Prill M;Chai SJ;Kirley PD;Alden NB;Kawasaki B;Yousey-Hindes K;Niccolai L;Anderson EJ;Openo KP;Weigel A;Monroe ML;Ryan P;Henderson J;Kim S;Como-Sabetti K;Lynfield R;Sosin D;Torres S;Muse A;Bennett NM;Billing L;Sutton M;West N;Schaffner W;Talbot HK;Aquino C;George A;Budd A;Brammer L;Langley G;Hall AJ;Fry A
通讯作者：
Fry A
影响因子：
158.5
作者：
Vaduganathan, Muthiah;Vardeny, Orly;Solomon, Scott D.
通讯作者：
Solomon, Scott D.
影响因子：
5.2
作者：
Wang, Bolin;Li, Ruobao;Huang, Yan
通讯作者：
Huang, Yan
影响因子：
24
作者：
Li, Juyi;Wang, Xiufang;Deng, Aiping
通讯作者：
Deng, Aiping
影响因子：
2.9
作者：
Kontopantelis, Evangelos;Stevens, Richard John;Ashcroft, Darren M.
通讯作者：
Ashcroft, Darren M.