Association of Renin-Angiotensin System Inhibitors With Severity or Risk of Death in Patients With Hypertension Hospitalized for Coronavirus Disease 2019 (COVID-19) Infection in Wuhan, China
Association of Renin-Angiotensin System Inhibitors With Severity or Risk of Death in Patients With Hypertension Hospitalized for Coronavirus Disease 2019 (COVID-19) Infection in Wuhan, China
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DOI：
10.1001/jamacardio.2020.1624
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发表时间：
2020-07-01
期刊：
影响因子：
24
通讯作者：
Deng, Aiping
中科院分区：
文献类型：
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作者：
Li, Juyi;Wang, Xiufang;Deng, Aiping
在高血压患者中，服用血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）的患者在因2019冠状病毒病（COVID-19）感染住院期间是否有更严重的疾病或死亡风险增加？结果在这个涉及362名因COVID-19感染住院的高血压患者的单中心病例系列中，与未接受治疗的患者相比，服用ACEI/ARB的患者的疾病严重程度、并发症和死亡风险没有差异这些药物。在这项单中心研究中，ACEI/ARB与住院高血压患者COVID-19感染的严重程度和结局无关。这些结果支持了目前治疗高血压的指南和社会建议。这项队列研究探讨了血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂与因COVID-19感染住院的高血压患者的疾病严重程度和死亡率之间的关系。重要性数据缺乏高血压患者是否正在服用血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）在因2019冠状病毒病（COVID-19）住院期间，严重程度或死亡风险增加。目的探讨ACEI/ARB与因COVID-19感染住院的高血压患者病情严重程度和死亡率的关系。设计、设置和参与者回顾性、单中心病例系列，纳入2020年1月15日至3月15日在中国武汉市中心医院住院的1178例COVID-19感染患者。通过实时逆转录-聚合酶链反应确认COVID-19，并对所有患者的流行病学、临床、放射学、实验室和药物治疗数据进行分析。比较重度与非重度高血压患者以及存活者与非存活者之间使用ACEI/ARB的高血压患者百分比。结果在1178例COVID-19患者中，中位年龄为55.5岁（四分位距，38-67岁），545例（46.3%）为男性。总的住院死亡率为11.0%。有362例高血压患者（占总组的30.7%;中位年龄66.0岁[四分位距59-73岁]; 189例[52.2%]为男性），其中115例（31.8%）正在服用ACEI/ARB。高血压患者的住院病死率为21.3%。重度和非重度感染患者中使用ACEI/ARB的高血压患者比例无差异（32.9% vs 30.7%; P = 0.65），非存活者和存活者之间也无差异（27.3% vs 33.0%; P = 0.34）。当分析服用ACEI和ARB的患者的数据时，观察到相似的结果。结论和相关性本研究提供了ACEI/ARB与因COVID-19感染住院的高血压患者结局相关性的临床数据，表明ACEI/ARB与此类患者COVID-19的严重程度或死亡率无关。这些数据支持COVID-19大流行期间治疗高血压的现行指南和社会建议。
Question Among patients with hypertension, do those taking angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) have greater illness severity or increased risk of mortality during hospitalization for coronavirus disease 2019 (COVID-19) infection? Findings In this single-center case series involving 362 patients with hypertension hospitalized with COVID-19 infection, there was no difference in severity of the disease, complications, and risk of death in those who were taking ACEIs/ARBs compared with those not treated with these medications. Meaning In this single-center study, ACEI/ARB was not associated with severity and outcomes of COVID-19 infection in hospitalized patients with hypertension. These results support current guidelines and societal recommendations for treating hypertension.This cohort study examines the association between angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and severity of illness and mortality in patients with hypertension hospitalized for COVID-19 infection.Importance Data are lacking whether patients with hypertension who are taking angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) have increased severity or risk of mortality during hospitalization for coronavirus disease 2019 (COVID-19). Objective To investigate the association between ACEIs/ARBs and severity of illness and mortality in patients with hypertension hospitalized for COVID-19 infection. Design, Setting, and Participants Retrospective, single-center case series of the 1178 hospitalized patients with COVID-19 infections at the Central Hospital of Wuhan, China, from January 15 to March 15, 2020. Main Outcomes and Measures COVID-19 was confirmed by real-time reverse transcription-polymerase chain reaction and epidemiologic, clinical, radiologic, laboratory, and drug therapy data were analyzed in all patients. The percentage of patients with hypertension taking ACEIs/ARBs was compared between those with severe vs nonsevere illness and between survivors vs nonsurvivors. Results Of the 1178 patients with COVID-19, the median age was 55.5 years (interquartile range, 38-67 years) and 545 (46.3%) were men. The overall in-hospital mortality was 11.0%. There were 362 patients with hypertension (30.7% of the total group; median age, 66.0 years [interquartile range, 59-73 years]; 189 [52.2%] were men), of whom 115 (31.8%) were taking ACEI/ARBs. The in-hospital mortality in the patients with hypertension was 21.3%. The percentage of patients with hypertension taking ACEIs/ARBs did not differ between those with severe and nonsevere infections (32.9% vs 30.7%; P = .65) nor did it differ between nonsurvivors and survivors (27.3% vs 33.0%; P = .34). Similar findings were observed when data were analyzed for patients taking ACEIs and those taking ARBs. Conclusions and Relevance This study provides clinical data on the association between ACEIs/ARBs and outcomes in patients with hypertension hospitalized with COVID-19 infections, suggesting that ACEIs/ARBs are not associated with the severity or mortality of COVID-19 in such patients. These data support current guidelines and societal recommendations for treating hypertension during the COVID-19 pandemic.