Association of Inpatient Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Mortality Among Patients With Hypertension Hospitalized With COVID-19
Association of Inpatient Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Mortality Among Patients With Hypertension Hospitalized With COVID-19
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住院患者使用血管紧张素转换酶抑制剂和血管紧张素 II 受体阻滞剂与因 COVID-19 住院的高血压患者死亡率之间的关系 [已发表的更正出现在 Circ Res 中
DOI：
10.1161/circresaha.120.317134
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发表时间：
2020-06-05
影响因子：
20.1
通讯作者：
Li, Hongliang
中科院分区：
文献类型：
--
作者：
Zhang, Peng;Zhu, Lihua;Li, Hongliang
补充数字内容可在文本中找到。基本原理：ACEI（血管紧张素转换酶抑制剂）和ARB（血管紧张素II受体阻滞剂）的使用是临床医生治疗2019冠状病毒病（COVID-19）高血压患者的主要问题。目的：确定高血压患者和因COVID-19住院患者的ACEI/ARB院内使用与全因死亡率之间的相关性。方法和结果：这项回顾性多中心研究纳入了1128例确诊为COVID-19的成年高血压患者，其中188例服用ACEI/ARB（ACEI/ARB组;中位年龄64 [四分位数范围，55-68]岁; 53.2%男性）和940例未使用ACEI/ARB的患者（非ACEI/ARB组;中位年龄64岁[四分位距57-69]; 53.5%男性），于2019年12月31日至2020年2月20日在中国湖北省9家医院住院。在混合效应考克斯模型中，治疗部位作为随机效应，在校正年龄、性别、合并症和住院药物后，ACEI/ARB组的全因死亡率检出风险低于非ACEI/ARB组（校正风险比，0.42 [95%CI，0.19-0.92]; P=0.03）。在混合效应考克斯模型中调整不平衡变量后的倾向评分匹配分析中，结果一致表明接受ACEI/ARB治疗的患者的COVID-19死亡风险低于未接受ACEI/ARB治疗的患者（调整后的风险比，0.37 [95%CI，0.15-0.89]; P=0.03）。进一步的亚组倾向评分匹配分析表明，与使用其他降压药物相比，ACEI/ARB也与COVID-19合并高血压患者的死亡率降低相关（校正风险比，0.30 [95%CI，0.12-0.70]; P=0.01）。结论：在患有COVID-19和并存高血压的住院患者中，与ACEI/ARB非使用者相比，ACEI/ARB住院使用者的全因死亡风险较低。虽然研究解释需要考虑潜在的残余混杂因素，但住院期间使用ACEI/ARB不太可能与死亡风险增加相关。
Supplemental Digital Content is available in the text. Rationale: Use of ACEIs (angiotensin-converting enzyme inhibitors) and ARBs (angiotensin II receptor blockers) is a major concern for clinicians treating coronavirus disease 2019 (COVID-19) in patients with hypertension. Objective: To determine the association between in-hospital use of ACEI/ARB and all-cause mortality in patients with hypertension and hospitalized due to COVID-19. Methods and Results: This retrospective, multi-center study included 1128 adult patients with hypertension diagnosed with COVID-19, including 188 taking ACEI/ARB (ACEI/ARB group; median age 64 [interquartile range, 55–68] years; 53.2% men) and 940 without using ACEI/ARB (non-ACEI/ARB group; median age 64 [interquartile range 57–69]; 53.5% men), who were admitted to 9 hospitals in Hubei Province, China from December 31, 2019 to February 20, 2020. In mixed-effect Cox model treating site as a random effect, after adjusting for age, gender, comorbidities, and in-hospital medications, the detected risk for all-cause mortality was lower in the ACEI/ARB group versus the non-ACEI/ARB group (adjusted hazard ratio, 0.42 [95% CI, 0.19–0.92]; P=0.03). In a propensity score-matched analysis followed by adjusting imbalanced variables in mixed-effect Cox model, the results consistently demonstrated lower risk of COVID-19 mortality in patients who received ACEI/ARB versus those who did not receive ACEI/ARB (adjusted hazard ratio, 0.37 [95% CI, 0.15–0.89]; P=0.03). Further subgroup propensity score-matched analysis indicated that, compared with use of other antihypertensive drugs, ACEI/ARB was also associated with decreased mortality (adjusted hazard ratio, 0.30 [95% CI, 0.12–0.70]; P=0.01) in patients with COVID-19 and coexisting hypertension. Conclusions: Among hospitalized patients with COVID-19 and coexisting hypertension, inpatient use of ACEI/ARB was associated with lower risk of all-cause mortality compared with ACEI/ARB nonusers. While study interpretation needs to consider the potential for residual confounders, it is unlikely that in-hospital use of ACEI/ARB was associated with an increased mortality risk.