Effects of Angiotensin II Receptor Blockers and ACE (Angiotensin-Converting Enzyme) Inhibitors on Virus Infection, Inflammatory Status, and Clinical Outcomes in Patients With COVID-19 and Hypertension A Single-Center Retrospective Study
Effects of Angiotensin II Receptor Blockers and ACE (Angiotensin-Converting Enzyme) Inhibitors on Virus Infection, Inflammatory Status, and Clinical Outcomes in Patients With COVID-19 and Hypertension A Single-Center Retrospective Study
复制标题
DOI：
10.1161/hypertensionaha.120.15143
复制
发表时间：
2020-07-01
期刊：
影响因子：
8.3
通讯作者：
He, Shaobin
中科院分区：
文献类型：
--
作者：
Yang, Guang;Tan, Zihu;He, Shaobin
由于能够诱导ACE 2（血管紧张素转换酶2）表达升高，严重急性呼吸综合征冠状病毒2的细胞受体，血管紧张素II受体阻滞剂（ARB）或ACE抑制剂治疗可能在促进病毒感染和减少致病性炎症方面具有争议性作用。我们的目的是在一项回顾性单中心研究中评估ARB/ACE抑制剂对2019冠状病毒病（COVID-19）的影响。将2020年1月5日至2月22日在武汉湖北省中医院接受治疗的126例既存高血压的COVID-19患者根据其降压药物回顾性分配至ARBs/ACE抑制剂组（n=43）和非ARBs/ACE抑制剂组（n=83）。随机选择125名年龄和性别匹配的COVID-19患者作为非高血压对照。此外，还回顾了2019年11月1日至12月31日（COVID-19爆发前）在湖北省中医院住院的1942例高血压患者的用药史，以进行外部比较。流行病学，人口统计学，临床和实验室数据收集，分析，并比较这些组之间。ARB/ACE抑制剂在伴或不伴COVID-19的高血压患者中的使用频率相当。在患有COVID-19和高血压的患者中，接受ARB/ACE抑制剂或非ARB/ACE抑制剂的患者的血压相当。然而，ARB/ACE抑制剂组的hs-CRP（高敏C反应蛋白;P=0.049）和PCT（降钙素原，P=0.008）浓度显著较低。此外，与非ARB/ACE抑制剂组相比，ARB/ACE抑制剂组中观察到的危重患者比例（9.3% vs 22.9%;P=0.061）和死亡率（4.7% vs 13.3%;P=0.216）较低，尽管这些差异未达到统计学显著性。因此，我们的研究结果支持ARB/ACE抑制剂用于COVID-19和既存高血压患者。
With the capability of inducing elevated expression of ACE2 (angiotensin-converting enzyme 2), the cellular receptor for severe acute respiratory syndrome coronavirus 2, angiotensin II receptor blockers (ARBs) or ACE inhibitors treatment may have a controversial role in both facilitating virus infection and reducing pathogenic inflammation. We aimed to evaluate the effects of ARBs/ACE inhibitors on coronavirus disease 2019 (COVID-19) in a retrospective, single-center study. One hundred twenty-six patients with COVID-19 and preexisting hypertension at Hubei Provincial Hospital of Traditional Chinese Medicine in Wuhan from January 5 to February 22, 2020, were retrospectively allocated to ARBs/ACE inhibitors group (n=43) and non-ARBs/ACE inhibitors group (n=83) according to their antihypertensive medication. One hundred twenty-five age- and sex-matched patients with COVID-19 without hypertension were randomly selected as nonhypertension controls. In addition, the medication history of 1942 patients with hypertension that were admitted to Hubei Provincial Hospital of Traditional Chinese Medicine from November 1 to December 31, 2019, before the COVID-19 outbreak were also reviewed for external comparison. Epidemiological, demographic, clinical, and laboratory data were collected, analyzed, and compared between these groups. The frequency of ARBs/ACE inhibitors usage in patients with hypertension with or without COVID-19 were comparable. Among patients with COVID-19 and hypertension, those received either ARBs/ACE inhibitors or non-ARBs/ACE inhibitors had comparable blood pressure. However, ARBs/ACE inhibitors group had significantly lower concentrations of hs-CRP (high-sensitivity C-reactive protein;P=0.049) and PCT (procalcitonin,P=0.008). Furthermore, a lower proportion of critical patients (9.3% versus 22.9%;P=0.061) and a lower death rate (4.7% versus 13.3%;P=0.216) were observed in ARBs/ACE inhibitors group than non-ARBs/ACE inhibitors group, although these differences failed to reach statistical significance. Our findings thus support the use of ARBs/ACE inhibitors in patients with COVID-19 and preexisting hypertension.