Could Anti-Hypertensive Drug Therapy Affect the Clinical Prognosis of Hypertensive Patients With COVID-19 Infection? Data From Centers of Southern Italy.
Could Anti-Hypertensive Drug Therapy Affect the Clinical Prognosis of Hypertensive Patients With COVID-19 Infection? Data From Centers of Southern Italy.
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DOI：
10.1161/jaha.120.016948
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发表时间：
2020-09
影响因子：
5.4
通讯作者：
Marfella R
中科院分区：
文献类型：
--
作者：
Sardu C;Maggi P;Messina V;Iuliano P;Sardu A;Iovinella V;Paolisso G;Marfella R
冠状病毒病2019 （COVID - 19）是一种大流行疾病的病因，在人类中通过血管紧张素转换酶2结合靶上皮肺细胞导致严重急性呼吸综合征。因此，合并COVID - 19的高血压患者预后可能较差。事实上，血管紧张素转换酶抑制剂和/或血管紧张素受体阻滞剂可能会干扰血管紧张素转换酶2的表达/活性。因此，接受血管紧张素转换酶抑制剂和/或血管紧张素受体阻滞剂药物治疗的高血压患者可能有更高的感染严重COVID - 19的风险，应予以监测。此外，在本研究中，我们研究了血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂和钙通道阻滞剂对62例因COVID - 19感染住院的高血压患者的机械通气、重症监护病房入院、心脏损伤和死亡等临床结果的影响。这项多中心研究是在卡塞塔圣安娜医院传染病科、那不勒斯坎帕尼亚大学“路易吉·凡维泰利”、那不勒斯坎帕尼亚大学“路易吉·凡维泰利”高级外科和医学科学系以及意大利那不勒斯“FIMG”综合医疗援助单位进行的前瞻性研究。左心室射血分数最低值预测死亡（1.142,1.008-1.294，P<0.05），白细胞介素- 6最高值预测重症监护病房入院（1.617,1.094-2.389）、机械通气（1.149,1.082-1.219）、心脏损伤（1.367,1.054-1.772）和死亡（4.742,1.788-8.524）。抗高血压药物不影响COVID - 19患者的预后。因此，除了慢性降压治疗外，量身定制的抗炎和免疫治疗可以防止预后恶化，并改善高血压合并COVID - 19感染患者的临床结果。
Coronavirus disease 2019 (COVID‐19) is the cause of a pandemic disease, with severe acute respiratory syndrome by binding target epithelial lung cells through angiotensin‐converting enzyme 2 in humans. Thus, patients with hypertension with COVID‐19 could have worse prognosis. Indeed, angiotensin‐converting enzyme inhibitors and/or angiotensin receptor blockers may interfere with angiotensin‐converting enzyme 2 expression/activity. Thus, patients with hypertension undergoing angiotensin‐converting enzyme inhibitor and/or angiotensin receptor blockers drug therapy may be at a higher risk of contracting a serious COVID‐19 infection and should be monitored. Moreover, in the present study we investigated the effects of angiotensin‐converting enzyme inhibitor versus angiotensin receptor blockers versus calcium channel blockers on clinical outcomes as mechanical ventilation, intensive care unit admissions, heart injury, and death in 62 patients with hypertension hospitalized for COVID‐19 infection. The multicenter study was prospectively conducted at Department of Infectious Diseases of Sant'Anna Hospital of Caserta, and of University of Campania "Luigi Vanvitelli" of Naples, at Department of Advanced Surgical and Medical Sciences of University of Campania "Luigi Vanvitelli," Naples, and at General Medical Assistance Unit "FIMG," Naples, Italy. Lowest values of left ventricle ejection fraction predicted deaths (1.142, 1.008–1.294, P<0.05), while highest values of interleukin‐6 predicted the admission to intensive care unit (1.617, 1.094–2.389), mechanical ventilation (1.149, 1.082–1.219), heart injuries (1.367, 1.054–1.772), and deaths (4.742, 1.788–8.524). Anti‐hypertensive drugs didn't affect the prognosis in patients with COVID‐19. Consequently, tailored anti‐inflammatory and immune therapies in addition to chronic antihypertensive therapy, could prevent a worse prognosis, as well as improve the clinical outcomes in patients with hypertension with COVID‐19 infection.