血管紧张素转换酶抑制剂或血管紧张素 II 受体阻滞剂与 COVID-19 住院高血压患者的预后。
Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers and prognosis of hypertensive patients hospitalised with COVID-19.
机构信息
Emergency Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
出版信息
Intern Med J. 2020 Dec;50(12):1483-1491. doi: 10.1111/imj.15078.
BACKGROUND
Among hypertensive patients, the association between treatment with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) and the clinical severity of COVID-19, remains uncertain.
AIMS
To determine whether hypertensive patients hospitalised with COVID-19 are at risk of worse outcomes if on treatment with ACEI or ARB compared to other anti-hypertensive medications.
METHODS
This is a retrospective study conducted at a single academic medical centre (Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy) from 1 to 31 March 2020. We compared patients on treatment with an ACEI/ARB (ACEI/ARB group) to patients receiving other anti-hypertensive medications (No-ACEI/ARB group). The end-points of the study were the all-cause in-hospital death and the combination of in-hospital death or need for intensive care unit (ICU) admission.
RESULTS
The sample included 166 COVID-19 patients; median age was 74 years and 109 (66%) were men. Overall, 111 (67%) patients were taking an ACEI or ARB. Twenty-nine (17%) patients died during the hospital stay, and 51 (31%) met the combined end-point. After adjustment for comorbidities, age and degree of severity at the presentation, ACEI or ARB treatment was an independent predictor neither of in-hospital death nor of the combination of in-hospital death/need for ICU. No differences were documented between treatment with ACEI compared to ARB.
CONCLUSIONS
Among hypertensive patients hospitalised for COVID-19, treatment with ACEI or ARB is not associated with an increased risk of in-hospital death.
背景
在高血压患者中，血管紧张素转换酶抑制剂（ACEI）或血管紧张素 II 受体阻滞剂（ARB）治疗与 COVID-19 临床严重程度之间的关系仍不确定。
目的
确定与其他抗高血压药物相比，因 COVID-19 住院的高血压患者使用 ACEI 或 ARB 是否有发生更差结局的风险。
方法
这是一项在意大利罗马 Fondazione Policlinico A. Gemelli IRCCS 单中心进行的回顾性研究。我们将使用 ACEI/ARB 的患者（ACEI/ARB 组）与接受其他抗高血压药物的患者（非 ACEI/ARB 组）进行比较。研究的终点是全因院内死亡和院内死亡或需要入住重症监护病房（ICU）的组合。
结果
该样本包括 166 例 COVID-19 患者；中位年龄为 74 岁，109 例（66%）为男性。总体而言，111 例（67%）患者正在服用 ACEI 或 ARB。29 例（17%）患者在住院期间死亡，51 例（31%）达到了联合终点。在校正合并症、年龄和就诊时的严重程度后，ACEI 或 ARB 治疗既不是院内死亡的独立预测因素，也不是院内死亡/需要 ICU 的联合预测因素。ACEI 与 ARB 治疗之间未记录到差异。
结论
在因 COVID-19 住院的高血压患者中，ACEI 或 ARB 治疗与院内死亡风险增加无关。
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