血管紧张素转换酶抑制剂和血管紧张素 II 受体阻滞剂与 COVID-19 严重程度的关联：一项多中心前瞻性研究。
Association of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Blockers With Severity of COVID-19: A Multicenter, Prospective Study.
机构信息
Pharmaceutical Care, 37852King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
出版信息
J Cardiovasc Pharmacol Ther. 2021 May;26(3):244-252. doi: 10.1177/1074248420976279. Epub 2020 Nov 24.
BACKGROUND
Speculations whether treatment with angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin II receptor blockers (ARB) predisposes to severe coronavirus disease 2019 (COVID-19) or worsens its outcomes. This study assessed the association of ACE-I/ARB therapy with the development of severe COVID-19.
METHODS
This multi-center, prospective study enrolled patients hospitalized for COVID-19 and receiving one or more antihypertensive agents to manage either hypertension or cardiovascular disease. ACE-I/ARB therapy associations with severe COVID-19 on the day of hospitalization, intensive care unit (ICU) admission, mechanical ventilation and in-hospital death on follow-up were tested using a multivariate logistic regression model adjusted for age, obesity, and chronic illnesses. The composite outcome of mechanical ventilation and death was examined using the adjusted Cox multivariate regression model.
RESULTS
Of 338 enrolled patients, 245 (72.4%) were using ACE-I/ARB on the day of hospital admission, and 197 continued ACE-I/ARB therapy during hospitalization. Ninety-eight (29%) patients had a severe COVID-19, which was not significantly associated with the use of ACE-I/ARB (OR 1.17, 95% CI 0.66-2.09; = .57). Prehospitalization ACE-I/ARB therapy was not associated with ICU admission, mechanical ventilation, or in-hospital death. Continuing ACE-I/ARB therapy during hospitalization was associated with decreased mortality (OR 0.22, 95% CI 0.073-0.67; = .008). ACE-I/ARB use was not associated with developing the composite outcome of mechanical ventilation and in-hospital death (HR 0.95, 95% CI 0.51-1.78; = .87) versus not using ACE-I/ARB.
CONCLUSION
Patients with hypertension or cardiovascular diseases receiving ACE-I/ARB therapy are not at increased risk for severe COVID-19 on admission to the hospital. ICU admission, mechanical ventilation, and mortality are not associated with ACE-I/ARB therapy. Maintaining ACE-I/ARB therapy during hospitalization for COVID-19 lowers the likelihood of death.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov, NCT4357535.
背景
有人推测血管紧张素转换酶抑制剂（ACE-I）或血管紧张素 II 受体阻滞剂（ARB）的治疗是否会导致严重的 2019 年冠状病毒病（COVID-19）或使其预后恶化。本研究评估了 ACE-I/ARB 治疗与严重 COVID-19 发生之间的关系。
方法
这是一项多中心前瞻性研究，纳入了因 COVID-19 住院并接受一种或多种降压药物治疗高血压或心血管疾病的患者。使用多变量逻辑回归模型调整年龄、肥胖和慢性疾病，检验 ACE-I/ARB 治疗与住院当天、重症监护病房（ICU）入院、机械通气和随访期间院内死亡的严重 COVID-19 的相关性。使用调整后的 Cox 多变量回归模型检查机械通气和死亡的复合结局。
结果
在 338 名入组患者中，245 名（72.4%）在住院当天使用 ACE-I/ARB，197 名在住院期间继续使用 ACE-I/ARB 治疗。98 名（29%）患者患有严重 COVID-19，但与 ACE-I/ARB 的使用无显著相关性（OR 1.17，95%CI 0.66-2.09； =.57）。住院前 ACE-I/ARB 治疗与 ICU 入院、机械通气或院内死亡无关。住院期间继续使用 ACE-I/ARB 治疗与死亡率降低相关（OR 0.22，95%CI 0.073-0.67； =.008）。与未使用 ACE-I/ARB 相比，ACE-I/ARB 的使用与机械通气和院内死亡的复合结局的发生无关（HR 0.95，95%CI 0.51-1.78； =.87）。
结论
接受 ACE-I/ARB 治疗的高血压或心血管疾病患者在入院时发生严重 COVID-19 的风险并未增加。ICU 入院、机械通气和死亡率与 ACE-I/ARB 治疗无关。COVID-19 住院期间维持 ACE-I/ARB 治疗可降低死亡的可能性。
临床试验注册
ClinicalTrials.gov，NCT04357535。
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