Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Withdrawal Is Associated with Higher Mortality in Hospitalized Patients with COVID-19

Journal of Clinical Medicine

卷:10

on behalf of the SEMI-COVID-19 Network¹  Francisco Arnalich²  Carmen Rosario Herrero Gil²  Aquilino Sánchez Purificación²  Emilia Roy-Vallejo³  María José García Blanco³  Beatriz Sánchez Moreno³  José Bascunana⁴  Begoña Cortés Rodríguez⁵  Manuel Rubio-Rivas⁶  Jorge Andrés Soler⁷  Jairo Luque del Pino⁸  Jesús Millán Núñez-Cortés⁹  Jesús Ballano Rodríguez-Solís¹⁰  José Manuel Casas-Rojo¹¹  María Sierra Navas-Alcántara¹²  Ricardo Gil Sánchez¹³  Amara González Noya¹⁴  Ana Suárez-Lombraña¹⁵  José Nicolás Alcalá¹⁶  Ricardo Gómez-Huelgas¹⁷  Verónica Martínez Sempere¹⁸  Sara Pintos Otero¹⁹  Juan Luis Romero-Cabrera²⁰  José López Miranda²⁰  José David Torres Peña²⁰ 

[1] ;

[2] Department of Internal Medicine, La Paz University Hospital, Hospital La Paz Institute for Health Research (IdiPAZ), Autonomous University of Madrid, 28046 Madrid, Spain;

[3] Department of Internal Medicine, La Princesa University Hospital, Healthcare Research Institute-La Princesa Biomedical Research Foundation, 28006 Madrid, Spain;

[4] Internal Medicine Department, 12 de Octubre University Hospital, 28041 Madrid, Spain;

[5] Internal Medicine Department, Alto Guadalquivir Hospital, 23740 Andújar, Spain;

[6] Internal Medicine Department, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain;

[7] Internal Medicine Department, Castellón University General Hospital, 12004 Castellón de la Plana, Spain;

[8] Internal Medicine Department, Costa del Sol Hospital, 29603 Marbella, Spain;

[9] Internal Medicine Department, Gregorio Marañón University Hospital, 28007 Madrid, Spain;

[10] Internal Medicine Department, Henares Hospital, 28822 Coslada, Spain;

[11] Internal Medicine Department, Infanta Cristina University Hospital, 28981 Parla, Spain;

[12] Internal Medicine Department, Infanta Margarita Hospital, 14940 Cabra, Spain;

[13] Internal Medicine Department, La Fe University Hospital, 46026 Valencia, Spain;

[14] Internal Medicine Department, Ourense University Hospital Complex, 32005 Ourense, Spain;

[15] Internal Medicine Department, Platón Hospital, 08006 Barcelona, Spain;

[16] Internal Medicine Department, Pozoblanco Hospital, 14400 Pozoblanco, Spain;

[17] Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), 29010 Málaga, Spain;

[18] Internal Medicine Department, San Juan de Alicante University Hospital, 03550 San Juan de Alicante, Spain;

[19] Internal Medicine Department, Zamora Hospital Complex, 49022 Zamora, Spain;

[20] Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, 14004 Córdoba, Spain;

关键词: COVID-19;    ACEI;    ARB;    prognosis;    MACE;   

DOI  :  10.3390/jcm10122642

来源: DOAJ

【 摘 要 】

Our main aim was to describe the effect on the severity of ACEI (angiotensin-converting enzyme inhibitor) and ARB (angiotensin II receptor blocker) during COVID-19 hospitalization. A retrospective, observational, multicenter study evaluating hospitalized patients with COVID-19 treated with ACEI/ARB. The primary endpoint was the incidence of the composite outcome of prognosis (IMV (invasive mechanical ventilation), NIMV (non-invasive mechanical ventilation), ICU admission (intensive care unit), and/or all-cause mortality). We evaluated both outcomes in patients whose treatment with ACEI/ARB was continued or withdrawn. Between February and June 2020, 11,205 patients were included, mean age 67 years (SD = 16.3) and 43.1% female; 2162 patients received ACEI/ARB treatment. ACEI/ARB treatment showed lower all-cause mortality (p < 0.0001). Hypertensive patients in the ACEI/ARB group had better results in IMV, ICU admission, and the composite outcome of prognosis (p < 0.0001 for all). No differences were found in the incidence of major adverse cardiovascular events. Patients previously treated with ACEI/ARB continuing treatment during hospitalization had a lower incidence of the composite outcome of prognosis than those whose treatment was withdrawn (RR 0.67, 95%CI 0.63–0.76). ARB was associated with better survival than ACEI (HR 0.77, 95%CI 0.62–0.96). ACEI/ARB treatment during COVID-19 hospitalization was associated with protection on mortality. The benefits were greater in hypertensive, those who continued treatment, and those taking ARB.

【 授权许可】

Unknown