Use of RAAS Inhibitors and Risk of Clinical Deterioration in COVID-19: Results From an Italian Cohort of 133 Hypertensives
Use of RAAS Inhibitors and Risk of Clinical Deterioration in COVID-19: Results From an Italian Cohort of 133 Hypertensives
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DOI：
10.1093/ajh/hpaa096
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发表时间：
2020-10-01
影响因子：
3.2
通讯作者：
Rattazzi, Marcello
中科院分区：
文献类型：
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作者：
Felice, Carla;Nardin, Chiara;Rattazzi, Marcello
背景：高血压患者长期使用肾素-血管紧张素-醛固酮系统(RAAS)抑制剂对新冠肺炎感染严重程度的影响尚不清楚。为探讨血管紧张素转换酶抑制剂(ACEI)或血管紧张素II受体阻滞剂(ARBS)的长期应用与高血压患者新冠肺炎预后的关系。方法采用单中心研究方法，对133例因急性呼吸道症状和/或发热而来急诊科就诊的高血压患者进行单中心研究。ACEI组和ARBS组在住院率、氧疗和无创呼吸机需求方面没有统计学差异。接受RAAS抑制剂治疗的患者与非RAAS患者相比，半重症/重症监护病房的入院率显著降低(优势比(OR)0.25，可信区间(CI)95%0.09~0.66，P=0.006)。同样，前者死亡风险较低，但差异无统计学意义(OR0.56，CI 95%0.17~1.83，P=0.341)。结论RAAS抑制剂的长期应用对高血压患者新冠肺炎的临床病程无负面影响。需要进一步的研究来证实这一发现，并确定RAAS抑制剂是否可能对新冠肺炎相关的发病率和死亡率具有保护作用。
BACKGROUNDThe effect of chronic use of renin-angiotensin-aldosterone system (RAAS) inhibitors on the severity of COVID-19 infection is still unclear in patients with hypertension. We aimed to investigate the association between chronic use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) and COVID-19-related outcomes in hypertensive patients.METHODSA single-center study was conducted on 133 consecutive hypertensive subjects presenting to the emergency department with acute respiratory symptoms and/or fever who were diagnosed with COVID-19 infection between 9 and 31 March 2020.RESULTSAll patients were grouped according to their chronic antihypertensive medications (ACEIs, N = 40; ARBs, N = 42; not on RAAS inhibitors, N = 51). There was no statistical difference between ACEIs and ARBs groups in terms of hospital admission rate, oxygen therapy, and need for noninvasive ventilation. Patients chronically treated with RAAS inhibitors showed a significantly lower rate of admission to semi-intensive/intensive care units, when compared with the non-RAAS population (odds ratio (OR) 0.25, confidence interval (CI) 95% 0.09-0.66, P= 0.006). Similarly, the risk of mortality was lower in the former group, although not reaching statistical significance (OR 0.56, CI 95% 0.17-1.83, P= 0.341).CONCLUSIONSOur data suggest that chronic use of RAAS inhibitors does not negatively affect clinical course of COVID-19 in hypertensive patients. Further studies are needed to confirm this finding and determine whether RAAS inhibitors may have a protective effect on COVID-19-related morbidity and mortality.