Association of outpatient use of renin-angiotensin-aldosterone system blockers on outcomes of acute respiratory illness during the COVID-19 pandemic: a cohort study.
Angiotensin Receptor Antagonists
/ therapeutic use
Angiotensin-Converting Enzyme Inhibitors
/ therapeutic use
COVID-19
Cohort Studies
Female
Humans
Hypertension
/ drug therapy
Influenza, Human
/ drug therapy
Male
Outpatients
Pandemics
Renin-Angiotensin System
Respiratory Distress Syndrome
Retrospective Studies
ACE inhibitors
COVID-19
acute viral respiratory illness
angiotensin receptor blockers
Journal
BMJ open
ISSN: 2044-6055
Titre abrégé: BMJ Open
Pays: England
ID NLM: 101552874
Informations de publication
Date de publication:
06 07 2022
06 07 2022
Historique:
entrez:
6
7
2022
pubmed:
7
7
2022
medline:
9
7
2022
Statut:
epublish
Résumé
Evaluate the associations between patients taking ACE inhibitors and angiotensin receptor blockers (ARBs) and their clinical outcomes after an acute viral respiratory illness (AVRI) due to COVID-19. Retrospective cohort. The USA; 2017-2018 influenza season, 2018-2019 influenza season, and 2019-2020 influenza/COVID-19 season. People with hypertension (HTN) taking an ACEi, ARB or other HTN medications, and experiencing AVRI. Change in hospital admission, intensive care unit (ICU) or coronary care unit (CCU), acute respiratory distress (ARD), ARD syndrome (ARDS) and all-cause mortality, comparing COVID-19 to pre-COVID-19 influenza seasons. The cohort included 1 059 474 episodes of AVRI (653 797 filled an ACEi or ARB, and 405 677 other HTN medications). 58.6% were women and 72.9% with age ≥65. The ACEi/ARB cohort saw a larger increase in risk in the COVID-19 influenza season than the other HTN medication cohort for four out of five outcomes, with an additional 1.5 percentage point (pp) increase in risk of an inpatient stay (95% CI 1.2 to 1.9 pp) and of ICU/CCU use (95% CI 0.3 to 2.7 pp) as well as a 0.7 pp (0.1 to 1.2 pp) additional increase in risk of ARD and 0.9 pp (0.4 to 1.3 pp) additional increase in risk of ARDS. There was no statistically significant difference in the absolute risk of death (-0.2 pp, 95% CI -0.4 to 0.1 pp). However, the relative risk of death in 2019/2020 versus 2017/2018 for the ACEi/ARB group was larger (1.40 (1.36 to 1.44)) than for the other HTN medication cohort (1.24 (1.21 to 1.28)). People with AVRI using ACEi/ARBs for HTN had a greater increase in poor outcomes during the COVID-19 pandemic than those using other medications to treat HTN. The small absolute magnitude of the differences likely does not support changes in clinical practice.
Identifiants
pubmed: 35793915
pii: bmjopen-2021-060305
doi: 10.1136/bmjopen-2021-060305
pmc: PMC9260198
doi:
Substances chimiques
Angiotensin Receptor Antagonists
0
Angiotensin-Converting Enzyme Inhibitors
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e060305Informations de copyright
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
JAMA. 2020 Apr 7;323(13):1239-1242
pubmed: 32091533
Clin Cardiol. 2020 Aug 5;:
pubmed: 32757246
Hypertension. 2020 Nov;76(5):1563-1571
pubmed: 32869673
Drugs. 2022 Jan;82(1):43-54
pubmed: 34914085
Int J Cardiol Heart Vasc. 2020 Dec;31:100627
pubmed: 32875060
Ann Intern Med. 2020 Aug 4;173(3):195-203
pubmed: 32422062
Eur Heart J Cardiovasc Pharmacother. 2021 Mar 15;7(2):148-157
pubmed: 32542337
Hypertension. 2021 Mar 3;77(3):846-855
pubmed: 33325240
Health Aff (Millwood). 2014 Jul;33(7):1187-94
pubmed: 25006145
Pharmacol Res Perspect. 2020 Dec;8(6):e00666
pubmed: 33084232
JAMA Intern Med. 2020 Oct 1;180(10):1328-1333
pubmed: 32744612
Diabetes Metab Syndr. 2020 Sep - Oct;14(5):983-990
pubmed: 32615377
Expert Rev Cardiovasc Ther. 2020 Dec;18(12):919-930
pubmed: 32945216
Lancet. 2020 Mar 28;395(10229):1054-1062
pubmed: 32171076
MMWR Morb Mortal Wkly Rep. 2020 Jun 26;69(25):790-794
pubmed: 32584797
PLoS Med. 2015 Oct 06;12(10):e1001885
pubmed: 26440803
Clin Infect Dis. 2021 Jun 1;72(11):e901-e913
pubmed: 33079200
Hypertension. 2020 Aug;76(2):e13-e14
pubmed: 32458694
Lancet Respir Med. 2021 Mar;9(3):275-284
pubmed: 33422263
Heart. 2020 Oct;106(19):1519-1524
pubmed: 32611676
Am Heart J Plus. 2022 Jan;13:100112
pubmed: 35252907
J Clin Pharm Ther. 2020 Dec;45(6):1244-1252
pubmed: 32767823
Am J Cardiol. 2020 Sep 1;130:159-161
pubmed: 32624189
J Med Virol. 2021 Mar;93(3):1370-1377
pubmed: 33095513
Curr Hypertens Rep. 2020 Sep 10;22(11):90
pubmed: 32910274
Clin Kidney J. 2021 Sep 03;15(1):79-94
pubmed: 35035939
Curr Atheroscler Rep. 2020 Aug 24;22(10):61
pubmed: 32830286
Am J Cardiovasc Drugs. 2020 Dec;20(6):571-590
pubmed: 32918209
Nature. 2020 Aug;584(7821):430-436
pubmed: 32640463
J Cardiovasc Pharmacol Ther. 2020 Nov;25(6):503-507
pubmed: 32748634
Med Care. 2005 Nov;43(11):1130-9
pubmed: 16224307
BMC Cardiovasc Disord. 2022 Mar 23;22(1):123
pubmed: 35321649
JAMA. 2021 Jan 19;325(3):254-264
pubmed: 33464336
Pharmacol Res. 2020 Aug;158:104927
pubmed: 32422341
J Cardiovasc Dev Dis. 2022 Jan 06;9(1):
pubmed: 35050225
J Infect. 2020 Aug;81(2):276-281
pubmed: 32474043
Eur Heart J Cardiovasc Pharmacother. 2020 Sep 1;6(5):335-337
pubmed: 32671399
Pharmacol Res. 2020 Oct;160:105053
pubmed: 32619721
N Engl J Med. 2020 Apr 23;382(17):1653-1659
pubmed: 32227760