Hypertension, renin-angiotensin-aldosterone-system-blocking agents, and COVID-19

Clinical Hypertension

Dong-Hoon Lee¹  In-Ho Chae²  Tae-Jin Youn²  Chang-Hwan Yoon²  Cheol-Ho Kim²  Si-Hyuck Kang³  Jin-Hyung Jung⁴  Sang-Hyun Park⁴  Kyung-Do Han⁵  Andrew M. Dai⁶  Henry G. Wei⁶ 

[1]Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

[2]Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

[3]Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea

[4]Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

[5]Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea

[6]Google, Mountain View, CA, USA

[7]Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

[8]Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea

[9]Google, Mountain View, CA, USA

关键词: Coronavirus infections;    Hypertension;    Angiotensin-converting enzyme inhibitors;    Angiotensin receptor antagonists;   

DOI  :  10.1186/s40885-021-00168-0

来源: Springer

【 摘 要 】

BackgroundThere have been concerns regarding the safety of renin-angiotensin-aldosterone-system (RAAS)-blocking agents including angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) during the coronavirus disease 2019 (COVID-19) pandemic. This study sought to evaluate the impact of hypertension and the use of ACEI/ARB on clinical severity in patients with COVID-19.MethodsA total of 3,788 patients aged 30 years or older who were confirmed with COVID-19 with real time reverse transcription polymerase chain reaction were identified from a claims-based cohort in Korea. The primary study outcome was severe clinical events, a composite of intensive care unit admission, need for ventilator care, and death.ResultsPatients with hypertension (n = 1,190, 31.4 %) were older and had higher prevalence of comorbidities than those without hypertension. The risk of the primary study outcome was significantly higher in the hypertension group, even after multivariable adjustment (adjusted odds ratio [aOR], 1.67; 95 % confidence interval [CI], 1.04 to 2.69). Among 1,044 patients with hypertensive medical treatment, 782 (74.9 %) were on ACEI or ARB. The ACEI/ARB subgroup had a lower risk of severe clinical outcomes compared to the no ACEI/ARB group, but this did not remain significant after multivariable adjustment (aOR, 0.68; 95 % CI, 0.41 to 1.15).ConclusionsPatients with hypertension had worse COVID-19 outcomes than those without hypertension, while the use of RAAS-blocking agents was not associated with increased risk of any adverse study outcomes. The use of ACE inhibitors or ARBs did not increase the risk of adverse COVID-19 outcomes, supporting current guidance to continue these medications when indicated.

【 授权许可】

CC BY