Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and COVID-19-related outcomes: A patient-level analysis of the PCORnet blood pressure control lab

American Heart Journal Plus

Marta G. Walsh¹  Raj A. Desai²  Faraz S. Ahmad³  Kruti Doshi⁴  Madelaine Faulkner⁵  Rhonda M. Cooper-DeHoff⁶  Mark J. Pletcher⁷  Catherine G. Derington⁸  Alanna M. Chamberlain⁸  Ester Kim Nilles⁹  Steven M. Smith^1,10  Katie Shaw^1,10  Daniel E. Ford^1,11  Cynthia H. Chuang^1,11  Emily C. O'Brien^1,12  Adam P. Bress^1,13  Myra Smith^1,14  Sravani Chandaka^1,15  Lav Parshottambhai Patel^1,16  Bradley W. Taylor^1,17  Anthony J. Viera^1,18  Elisa Priest^1,19  James McClay^1,19  Jyotsna Fuloria^2,20 

[1] Corresponding author at: University of Florida, 100486 Gainesville, FL, United States of America.;Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States of America;White Health, Dallas, TX, United States of America;;Baylor Scott &Cook County Health, Chicago, IL, United States of America;;Department of Epidemiology &Department of Family Medicine and Community Health, School of Medicine, Duke University, Durham, NC, United States of America;Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States of America;Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States of America;Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, United States of America;Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, UT, United States of America;Departments of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America;Departments of Quantitative Health Sciences and Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America;Duke Clinical Research Institute, Duke University, Durham, NC, United States of America;Johns Hopkins University, Baltimore, MD, United States of America;Medical College of Wisconsin, Milwaukee, WI, United States of America;Penn State University, Hershey, PA, United States of America;School of Medicine, Louisiana State University, New Orleans, LA, United States of America;University of Kansas Medical Center, Kansas City, KS, United States of America;University of Nebraska, Omaha, NE, United States of America;

关键词: Covid-19;    ACE inhibitors;    ARBs;    PCORnet;    Hypertension;   

DOI  :  

来源: DOAJ

【 摘 要 】

SARS-CoV-2 accesses host cells via angiotensin-converting enzyme-2, which is also affected by commonly used angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), raising concerns that ACEI or ARB exposure may portend differential COVID-19 outcomes. In parallel cohort studies of outpatient and inpatient COVID-19-diagnosed adults with hypertension, we assessed associations between antihypertensive exposure (ACEI/ARB vs. non-ACEI/ARB antihypertensives, as well as between ACEI- vs. ARB) at the time of COVID-19 diagnosis, using electronic health record data from PCORnet health systems. The primary outcomes were all-cause hospitalization or death (outpatient cohort) or all-cause death (inpatient), analyzed via Cox regression weighted by inverse probability of treatment weights. From February 2020 through December 9, 2020, 11,246 patients (3477 person-years) and 2200 patients (777 person-years) were included from 17 health systems in outpatient and inpatient cohorts, respectively. There were 1015 all-cause hospitalization or deaths in the outpatient cohort (incidence, 29.2 events per 100 person-years), with no significant difference by ACEI/ARB use (adjusted HR 1.01; 95% CI 0.88, 1.15). In the inpatient cohort, there were 218 all-cause deaths (incidence, 28.1 per 100 person-years) and ACEI/ARB exposure was associated with reduced death (adjusted HR, 0.76; 95% CI, 0.57, 0.99). ACEI, versus ARB exposure, was associated with higher risk of hospitalization in the outpatient cohort, but no difference in all-cause death in either cohort. There was no evidence of effect modification across pre-specified baseline characteristics. Our results suggest ACEI and ARB exposure have no detrimental effect on hospitalizations and may reduce death among hypertensive patients diagnosed with COVID-19.

【 授权许可】

Unknown