Renin-Angiotensin-Aldosterone System Inhibitors and Risk of Covid-19
Renin-Angiotensin-Aldosterone System Inhibitors and Risk of Covid-19
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DOI：
10.1056/nejmoa2008975
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发表时间：
2020-06-18
影响因子：
158.5
通讯作者：
Hochman, Judith S.
中科院分区：
文献类型：
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作者：
Reynolds, Harmony R.;Adhikari, Samrachana;Hochman, Judith S.
人们担心，服用肾素-血管紧张素-醛固酮系统抑制剂的患者患新冠病毒的风险会增加，因为血管紧张素转换酶2是该病毒的受体。这项研究显示，服用五种常见抗高血压药物中任何一种的患者，新冠肺炎检测阳性或严重新冠肺炎的可能性都没有增加。背景人们担心，在暴露于冠状病毒疾病的患者中，作用于肾素-血管紧张素-醛固酮系统的药物可能会增加风险2019（Covid-19），因为病毒受体是血管紧张素转换酶2（ACE 2）。方法我们评估了既往使用ACE抑制剂、血管紧张素受体阻滞剂、β受体阻滞剂、钙通道阻滞剂或噻嗪类利尿剂治疗与COVID-19检测阳性或阴性结果的可能性之间的关系，以及检测阳性患者发生严重疾病（定义为重症监护、机械通气或死亡）的可能性。使用贝叶斯方法，我们比较了接受这些药物治疗的患者和未接受治疗的患者的结局，总体和高血压患者，在接受每种药物类别的倾向评分匹配后。至少10个百分点的差异被预先规定为实质性差异。结果在12,594名接受新冠病毒检测的患者中，共有5894人（46.8%）呈阳性;其中1002人（17.0%）患有严重疾病。4357例患者（34.6%）有高血压病史，其中2573例（59.1%）检测阳性;其中634例（24.6%）患有严重疾病。任何单一药物类别与阳性检测可能性增加之间没有关联。在检测呈阳性的患者中，没有一种药物与严重疾病风险的大幅增加有关。结论我们发现，在与五类常见降压药物相关的检测呈阳性的患者中，新冠肺炎检测呈阳性的可能性或严重新冠肺炎的风险并未大幅增加。
There is concern that patients taking renin-angiotensin-aldosterone system inhibitors have an increased risk of Covid-19, because angiotensin-converting enzyme 2 is a receptor for the virus. This study showed no increase in likelihood of a positive Covid-19 test or severe Covid-19 in patients taking any of five common classes of antihypertensive drugs.Background There is concern about the potential of an increased risk related to medications that act on the renin-angiotensin-aldosterone system in patients exposed to coronavirus disease 2019 (Covid-19), because the viral receptor is angiotensin-converting enzyme 2 (ACE2). Methods We assessed the relation between previous treatment with ACE inhibitors, angiotensin-receptor blockers, beta-blockers, calcium-channel blockers, or thiazide diuretics and the likelihood of a positive or negative result on Covid-19 testing as well as the likelihood of severe illness (defined as intensive care, mechanical ventilation, or death) among patients who tested positive. Using Bayesian methods, we compared outcomes in patients who had been treated with these medications and in untreated patients, overall and in those with hypertension, after propensity-score matching for receipt of each medication class. A difference of at least 10 percentage points was prespecified as a substantial difference. Results Among 12,594 patients who were tested for Covid-19, a total of 5894 (46.8%) were positive; 1002 of these patients (17.0%) had severe illness. A history of hypertension was present in 4357 patients (34.6%), among whom 2573 (59.1%) had a positive test; 634 of these patients (24.6%) had severe illness. There was no association between any single medication class and an increased likelihood of a positive test. None of the medications examined was associated with a substantial increase in the risk of severe illness among patients who tested positive. Conclusions We found no substantial increase in the likelihood of a positive test for Covid-19 or in the risk of severe Covid-19 among patients who tested positive in association with five common classes of antihypertensive medications.