Huang W, Li T, Ling Y, Qian Z P, Zhang Y Y, Huang D, Xu S B, Liu X H, Xia L, Yang Y, Lu S H, Lu H Z
Department of Tuberculosis, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China.
Deparment of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China.
Zhonghua Nei Ke Za Zhi. 2020 Sep 1;59(9):689-694. doi: 10.3760/cma.j.cn112138-20200229-00155.
To analyze the effects of angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) on coronavirus disease 2019 (COVID-19) patients with hypertension, and to provide an evidence for selecting antihypertensive drugs in those patients. Clinical data were retrospectively analyzed in 58 COVID-19 patients with hypertension admitted to Shanghai Public Health Clinical Center from January 20 to February 22, 2020, including epidemiological history, clinical manifestations, laboratory findings, chest CT and outcome. Patients were divided into ACEI/ARB group and non-ACEI/ARB group. Twenty-six patients were in ACEI/ARB group and the other 32 patients in non-ACEI/ARB group, with median age 64.0 (49.5, 72.0) years and 64.0 (57.0, 68.8) years respectively. The median time to onset was 5(3, 8) days in ACEI/ARB group and 4 (3, 7) days in non-ACEI/ARB group, the proportion of patients with severe or critical illness was 19.2% and 15.6% respectively. The main clinical symptoms in two groups were fever (80.8% vs. 84.4%) and cough (23.1% vs. 31.3%). The following parameters were comparable including lymphocyte counts, C-reactive protein, lactate dehydrogenase, D-dimer, bilateral involvement in chest CT (76.9% vs. 71.9%), worsening of COVID-19 (15.4% vs. 9.4%), favorable outcome (92.3% vs. 96.9%) between ACEI/ARB group and non-ACEI/ARB group respectively (all 0.05). However, compared with non-ACEI/ARB group, serum creatinine [80.49 (68.72, 95.30) μmol/L vs. 71.29 (50.98, 76.98) μmol/L, 0.007] was higher significantly in ACEI/ARB group. ACEI/ARB drugs have no significant effects on baseline clinical parameters (serum creatine and myoglobin excluded) , outcome, and prognosis of COVID-19 patients with hypertension. Antihypertensive drugs are not suggested to adjust in those patients, but the potential impairment of renal function as elevation of serum creatinine should be paid attention in patients administrating ACEI/ARB drugs.
分析血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（ACEI/ARB）对新型冠状病毒肺炎（COVID-19）合并高血压患者的影响，为该类患者选择降压药物提供依据。回顾性分析2020年1月20日至2月22日收治于上海公共卫生临床中心的58例COVID-19合并高血压患者的临床资料，包括流行病学史、临床表现、实验室检查结果、胸部CT及转归。将患者分为ACEI/ARB组和非ACEI/ARB组。ACEI/ARB组26例，非ACEI/ARB组32例，中位年龄分别为64.0（49.5，72.0）岁和64.0（57.0，68.8）岁。ACEI/ARB组发病中位时间为5（3，8）天，非ACEI/ARB组为4（3，7）天，重症或危重症患者比例分别为19.2%和15.6%。两组主要临床症状为发热（80.8%对84.4%）和咳嗽（23.1%对31.3%）。ACEI/ARB组与非ACEI/ARB组以下参数具有可比性，包括淋巴细胞计数、C反应蛋白、乳酸脱氢酶、D-二聚体、胸部CT双侧受累情况（76.9%对71.9%）、COVID-19病情恶化情况（15.4%对9.4%）、良好转归情况（92.3%对96.9%）（均P>0.05）。然而，与非ACEI/ARB组相比，ACEI/ARB组血清肌酐[80.49（68.72，95.30）μmol/L对71.29（50.98，76.98）μmol/L，P=0.007]显著升高。ACEI/ARB类药物对COVID-19合并高血压患者的基线临床参数（排除血清肌酸和肌红蛋白）、转归及预后无显著影响。不建议对该类患者调整降压药物，但应用ACEI/ARB类药物的患者应注意血清肌酐升高所致的潜在肾功能损害。
