Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA.
BMJ Open. 2021 Mar 17;11(3):e044010. doi: 10.1136/bmjopen-2020-044010.
Evaluate associations between ACE inhibitors (ACEis) and angiotensin receptor blockers (ARBs) and clinical outcomes in acute viral respiratory illness (AVRI).
Retrospective cohort analysis of claims data.
The USA; 2018-2019 influenza season.
Main cohort: people with hypertension (HTN) taking an ACEi, ARB or other HTN medications, and experiencing AVRI. Falsification cohort: parallel cohort receiving elective knee or hip replacement.
Main cohort: hospital admission, intensive care unit, acute respiratory distress (ARD), ARD syndrome and all-cause mortality. Falsification cohort: complications after surgery and all-cause mortality.
The main cohort included 236 843 episodes of AVRI contributed by 202 629 unique individuals. Most episodes were in women (58.9%), 81.4% in people with Medicare Advantage and 40.3% in people aged 75+ years. Odds of mortality were lower in the ACEi (0.78 (0.74 to 0.83)) and ARB (0.64 (0.61 to 0.68)) cohorts compared with other HTN medications. On all other outcomes, people taking ARBs (but not ACEis) had a >10% reduction in odds of inpatient stays compared with other HTN medications.In the falsification analysis (N=103 353), both ACEis (0.89 (0.80 to 0.98)) and ARBs (0.82 (0.74 to 0.91)) were associated with decreased odds of complications compared with other HTN medications; ARBs (0.64 (0.47 to 0.87)) but not ACEis (0.79 (0.60 to 1.05)) were associated with lower odds of death compared with other HTN medications.
Outpatient use of ARBs was associated with better outcomes with AVRI compared with other medications for HTN. ACEis were associated with reduced risk of death, but with minimal or no reduction in risk of other complications. A falsification analysis conducted to provide context on the possible causal implications of these findings did not provide a clear answer. Further analysis using observational data will benefit from additional approaches to assess causal relationships between these drugs and outcomes in AVRI.
评估血管紧张素转换酶抑制剂（ACEi）和血管紧张素受体阻滞剂（ARB）与急性病毒性呼吸道感染（AVRI）临床结局之间的关联。
回顾性队列分析。
美国；2018-2019 年流感季节。
主要队列：患有高血压（HTN）的人群，正在服用 ACEi、ARB 或其他 HTN 药物，并且患有 AVRI。伪造队列：接受选择性膝关节或髋关节置换的平行队列。
主要队列：住院、重症监护病房、急性呼吸窘迫（ARD）、ARD 综合征和全因死亡率。伪造队列：手术后并发症和全因死亡率。
主要队列包括 236843 例 AVRI 发作，由 202629 名独特个体贡献。大多数发作发生在女性（58.9%），81.4%的人参加了 Medicare Advantage，40.3%的人年龄在 75 岁以上。与其他 HTN 药物相比，ACEi（0.78（0.74 至 0.83））和 ARB（0.64（0.61 至 0.68））队列的死亡率较低。在所有其他结局中，与其他 HTN 药物相比，服用 ARB（但不是 ACEi）的人住院的可能性降低了 10%以上。在伪造分析（N=103353）中，ACEi（0.89（0.80 至 0.98））和 ARB（0.82（0.74 至 0.91））均与其他 HTN 药物相比，并发症的可能性降低相关；ARB（0.64（0.47 至 0.87））但不是 ACEi（0.79（0.60 至 1.05））与其他 HTN 药物相比，死亡率降低的可能性较低。
与其他 HTN 药物相比，AVRI 门诊使用 ARB 与更好的结局相关。ACEi 与死亡风险降低相关，但与其他并发症风险降低无关或仅略有降低。为了提供对这些发现可能的因果影响的背景信息而进行的伪造分析并没有提供明确的答案。使用观察性数据进行的进一步分析将受益于评估这些药物与 AVRI 结局之间因果关系的其他方法。
