The role of anti-hypertensive treatment, comorbidities and early introduction of LMWH in the setting of COVID-19: A retrospective, observational study in Northern Italy

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:324

Article

Desai, Antonio^1,2  Voza, Giuseppe¹  Paiardi, Silvia¹  Teofilo, Francesca Ilaria¹  Caltagirone, Giuseppe¹  Pons, Marta Ripoll¹  Aloise, Monia¹  Kogan, Maria¹  Tommasini, Tobia³  Savevski, Victor³  Stefanini, Giulio⁴  Angelini, Claudio⁵  Ciccarelli, Michele⁶  Badalamenti, Salvatore⁵  De Nalda, Ana Lleo^2,7  Aghemo, Alessio^2,7  Cecconi, Maurizio^2,8  Boneschi, Filippo Martinelli^9,10,11  Voza, Antonio¹ 

[1] IRCCS, Humanitas Clin & Res Ctr, Emergency Dept, Milan, Italy

[2] Humanitas Univ, Dept Biomed Sci, Pieve Emanuele, Italy

[3] IRCCS, Humanitas Clin & Res Ctr, Artificial Intelligence Ctr, Milan, Italy

[4] IRCCS, Humanitas Clin & Res Ctr, Cardiol Dept, Milan, Italy

[5] Humanitas Clin & Res Ctr, Nephrol Unit, Milan, Italy

[6] Humanitas Clin & Res Ctr, Pneumol Dept, Milan, Italy

[7] Humanitas Univ, Humanitas Clin & Res Ctr, IRCCS, Dept Internal Med & Hepatol, Milan, Italy

[8] Humanitas Clin & Res Ctr, Dept & Anaesthesia & Intens Care, Milan, Italy

[9] Univ Milan, Dept Pathophysiol & Transplantat DEPT, Neurosci Sect, Dino Ferrari Ctr, Milan, Italy

[10] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Neurol Unit, Milan, Italy

[11] Fdn IRCCS Ca Granda Osped Maggiore Policlin, MS Ctr, Milan, Italy

关键词: ACE-I;    ARBs;    RAAS;    Cardiovascular;    Epidemiology;    Hypertension;   

DOI  :  10.1016/j.ijcard.2020.09.062

来源: Elsevier

【 摘 要 】

Background: There is a great deal of debate about the role of cardiovascular comorbidities and the chronic use of antihypertensive agents (such as ACE-I and ARBs) on mortality on COVID-19 patients. Of note, ACE2 is responsible for the host cell entry of the virus. Methods: We extracted data on 575 consecutive patients with laboratory-confirmed SARS-CoV-2 infection admitted to the Emergency Department (ED) of Humanitas Center, between February 21 and April 14, 2020. The aim of the study was to evaluate the role of chronic treatment with ACE-I or ARBs and other clinical predictors on in-hospital mortality in a cohort of COVID-19 patients. Results: Multivariate analysis showed that a chronic intake of ACE-I was associated with a trend in reduction of mortality (OR: 0.53; 95% CI: 0.27-1.03; p = 0.06), differently from a chronic intake of ARB (OR: 1.1; 95% CI: 0.5-2.8; p=0.8). Increased age (ORs ranging from 3.4 to 25.2 and to 39.5 for 60-70, 70-80 and >80 years vs <60) and cardiovascular comorbidities (OR: 1.90; 95% CI: 1.1-3.3; p = 0.02) were confirmed as important risk factors for COVID-19 mortality. Timely treatment with low-molecular-weight heparin (LMWH) in ED was found to be protective (OR: 0.36; 95% CI: 0.21-0.62; p < 0.0001). Conclusions: This study can contribute to understand the reasons behind the high mortality rate of patients in Lombardy, a region which accounts for >50% of total Italian deaths. Based on our findings, we support that daily intake of antihypertensive medications in the setting of COVID-19 should not be discontinued and that a timely LMWH administration in ED has shown to decrease in-hospital mortality. (C) 2020 Elsevier B.V. All rights reserved.

【 授权许可】

Free