Golpe Rafael, Pérez-de-Llano Luis A, Dacal David, Guerrero-Sande Hector, Pombo-Vide Beatriz, Ventura-Valcárcel Pablo
Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, Spain.
Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, Spain.
Med Clin (Engl Ed). 2020 Dec 11;155(11):488-490. doi: 10.1016/j.medcle.2020.06.028. Epub 2020 Dec 14.
There is controversy concerning the use of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II type-I receptor blockers (ARB) for treating hypertensive patients with Covid-19. It has been hypothesized that these drugs might increase the risk of severe Covid-19, but some authors suggested that blocking the renin-angiotensin system might actually decrease this risk.
Retrospective cohort study of all the consecutive hypertensive patients with confirmed SARS-CoV-2 infection in a health area. The outcome variable was hospitalization because of severe Covid-19.
539 subjects were diagnosed of SARS-CoV-2 infection. Of these, 157 (29.1%) had hypertension and were included in the study. Sixty-nine cases (43.9%) were hospitalized because of severe Covid-19. In multivariable analysis older age, diabetes and hypertensive myocadiopathy were related to a higher risk of hospital admission. ARB treatment was associated with a significantly lower risk of hospitalization (HR: 0.29, 95% CI: 0.10 - 0.88). A similar albeit not significant trend was observed for ACEI.
ARB or ACEI treatment was not associated with a worse clinical outcome in consecutive hypertensive patients infected by SARS-CoV-2.
关于使用血管紧张素转换酶抑制剂（ACEI）或血管紧张素II 1型受体阻滞剂（ARB）治疗新冠病毒肺炎（Covid-19）高血压患者存在争议。据推测，这些药物可能会增加严重Covid-19的风险，但一些作者认为阻断肾素-血管紧张素系统实际上可能会降低这种风险。
对某健康区域内所有连续确诊感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的高血压患者进行回顾性队列研究。观察变量为因严重Covid-19住院情况。
539名受试者被诊断为SARS-CoV-2感染。其中，157名（29.1%）患有高血压并纳入研究。69例（43.9%）因严重Covid-19住院。多变量分析显示，年龄较大、糖尿病和高血压性心肌病与住院风险较高相关。ARB治疗与显著较低的住院风险相关（风险比：0.29，95%置信区间：0.10 - 0.88）。ACEI也观察到类似但不显著的趋势。
在连续感染SARS-CoV-2的高血压患者中，ARB或ACEI治疗与较差的临床结局无关。
