Chronic use of renin-angiotensin-aldosterone system blockers and mortality in COVID-19: A multicenter prospective cohort and literature review.
Aged
Aged, 80 and over
Angiotensin II Type 1 Receptor Blockers
/ adverse effects
Angiotensin-Converting Enzyme Inhibitors
/ adverse effects
COVID-19
/ mortality
Cohort Studies
Female
France
Humans
Hypertension
Male
Middle Aged
Pandemics
Propensity Score
Prospective Studies
Renin-Angiotensin System
/ drug effects
COVID-19
RAAS blockers
angiotensin antagonists
hypertension
mortality
propensity score
Journal
Fundamental & clinical pharmacology
ISSN: 1472-8206
Titre abrégé: Fundam Clin Pharmacol
Pays: England
ID NLM: 8710411
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
revised:
22
03
2021
received:
07
01
2021
accepted:
14
04
2021
pubmed:
21
4
2021
medline:
19
11
2021
entrez:
20
4
2021
Statut:
ppublish
Résumé
The role of renin-angiotensin-aldosterone system (RAAS) blockers on the course of coronavirus disease 2019 (COVID-19) is debated. We assessed the association between chronic use of RAAS blockers and mortality among inpatients with COVID-19 and explored reasons for discrepancies in the literature. We included adult hypertensive patients from a prospective nationwide cohort of 3512 inpatients with COVID-19 up to June 30, 2020. Cox proportional hazard models with various adjustment or propensity weighting methods were used to estimate the hazard ratios (HR) of 30-day mortality for chronic users versus non-users of RAAS blockers. We analyzed data of 1160 hypertensive patients: 719 (62%) were male and 777 (67%) were older than 65 years. The main comorbidities were diabetes (n = 416, 36%), chronic cardiac disease (n = 401, 35%), and obesity (n = 340, 29%); 705 (61%) received oxygen therapy. We recorded 135 (11.6%) deaths within 30 days of diagnosis. We found no association between chronic use of RAAS blockers and mortality (unadjusted HR = 1.13, 95% CI [0.8-1.6]; propensity inverse probability treatment weighted HR = 1.09 [0.86-1.39]; propensity standardized mortality ratio weighted HR = 1.08 [0.79-1.47]). Our comprehensive review of previous studies highlighted that significant associations were mostly found in unrestricted populations with inappropriate adjustment, or with biased in-hospital exposure measurement. Our results do not support previous concerns regarding these drugs, nor a potential protective effect as reported in previous poorly designed studies and meta-analyses. RAAS blockers should not be discontinued during the pandemic, while in-hospital management of these drugs will be clarified by randomized trials. NCT04262921.
Identifiants
pubmed: 33876439
doi: 10.1111/fcp.12683
pmc: PMC8250758
doi:
Substances chimiques
Angiotensin II Type 1 Receptor Blockers
0
Angiotensin-Converting Enzyme Inhibitors
0
Banques de données
ClinicalTrials.gov
['NCT04262921']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1141-1158Subventions
Organisme : French Ministry of Health
ID : PHRC20-0424
Investigateurs
Marie Bartoli
(M)
Alpha Diallo
(A)
Soizic Le Mestre
(S)
Noémie Mercier
(N)
Christelle Paul
(C)
Ventzislava Petrov-Sanchez
(V)
Claire Andrejak
(C)
Denis Malvy
(D)
François Dubos
(F)
François Bompart
(F)
Tristan Gigante
(T)
Morgane Gilg
(M)
Bénédicte Rossignol
(B)
Claire Léy-Marchal
(C)
Marine Beluze
(M)
Delphine Bachelet
(D)
Krishna Bhavsar
(K)
Lila Bouadma
(L)
Anissa Chair
(A)
Camille Couffignal
(C)
Charlene Da Silveira
(C)
Marie-Pierre Debray
(MP)
Diane Descamps
(D)
Xavier Duval
(X)
Philippine Eloy
(P)
Marina Esposito-Farèse
(M)
Nadia Ettalhaoui
(N)
Isabelle Gorenne
(I)
Isabelle Hoffmann
(I)
Ouifiya Kafif
(O)
Sabrina Kali
(S)
Antoine Khalil
(A)
Cédric Laouénan
(C)
Samira Laribi
(S)
Minh Lê
(M)
Quentin Le Hingrat
(Q)
François-Xavier Lescure
(FX)
Jean-Christophe Lucet
(JC)
France Mentré
(F)
Jimmy Mullaert
(J)
Nathan Peiffer-Smadja
(N)
Gilles Peytavin
(G)
Carine Roy
(C)
Marion Schneider
(M)
Nassima Si Mohammed
(N)
Lysa Tagherset
(L)
Coralie Tardivon
(C)
Marie-Capucine Tellier
(MC)
Jean-François Timsit
(JF)
Théo Trioux
(T)
Sarah Tubiana
(S)
Benoît Visseaux
(B)
Yazdan Yazdanpanah
(Y)
Dominique Deplanque
(D)
Noémie Vanel
(N)
Romain Basmaci
(R)
Olivier Picone
(O)
François Angoulvant
(F)
Florentia Kaguelidou
(F)
Justine Pages
(J)
Christelle Tual
(C)
Aurélie Veislinger
(A)
Sandrine Couffin-Cadiergues
(S)
Hélène Esperou
(H)
Ikram Houas
(I)
Salma Jaafoura
(S)
Aurélie Papadopoulos
(A)
Alexandra Coelho
(A)
Alphonsine Diouf
(A)
Alexandre Hoctin
(A)
Marina Mambert
(M)
Maude Bouscambert
(M)
Alexandre Gaymard
(A)
Bruno Lina
(B)
Manuel Rosa-Calatrava
(M)
Olivier Terrier
(O)
Dehbia Benkerrou
(D)
Céline Dorival
(C)
Amina Meziane
(A)
François Téoulé
(F)
Jérémie Guedj
(J)
Hervé Le Nagard
(H)
Guillaume Lingas
(G)
Nadège Neant
(N)
Laurent Abel
(L)
Mathilde Desvallée
(M)
Coralie Khan
(C)
Sylvie Behilill
(S)
Vincent Enouf
(V)
Hugo Mouquet
(H)
Sylvie Van der Werf
(S)
Minerva Cervantes-Gonzalez
(M)
Eric D'Ortenzio
(E)
Oriane Puéchal
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Caroline Semaille
(C)
Marion Noret
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Yves Levy
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Aurélie Wiedemann
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Mélanie Roriz
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Patrick Rispal
(P)
Sarah Redl
(S)
Laurent Lefebvre
(L)
Pascal Granier
(P)
Laurence Maulin
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Cédric Joseph
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Julien Moyet
(J)
Cinthia Rames
(C)
Rafael Mahieu
(R)
Alexandra Ducancelle
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Vincent Dubee
(V)
Stéphane Sallaberry
(S)
Aldric Manuel
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Gabriel Macheda
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Amélie Valran
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Stéphane Jaureguiberry
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Antoine Cheret
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Gwenhaël Colin
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Romain Decours
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Thomas Guimard
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Vincent Langlois
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Laure Goubert
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Hikombo Hitoto
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Saad Nseir
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Mercé Jourdain
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Informations de copyright
© 2021 Société Française de Pharmacologie et de Thérapeutique.
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