Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Università degli Studi di Milano, Milan, Italy.
Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università Degli Studi di Milano, Milan, Italy.
Adv Ther. 2021 May;38(5):2709-2716. doi: 10.1007/s12325-021-01704-y. Epub 2021 Apr 1.
At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, controversial data were reported concerning angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) that induced a number of physicians to stop using them in patients with COVID-19. Although large-scale studies have ruled out this concern, it is common experience that patients with COVID-19 taking ACE inhibitors or ARBs are at increased risk of death. The aim of this study was to investigate the reasons for this apparently high mortality rate.
During the first wave of the pandemic, we conducted a field study of 427 consecutive patients with COVID-19 upon their admission to the emergency department of a hospital in one of the most severely hit cities in northern Italy, and 30 days later. The disease was defined as being mild, moderate or severe on the basis of clinical, laboratory and imaging data, and a multivariate model was used to analyse the determinants of mortality.
Within 30 days of admission, 31.6% of the patients treated with ACE inhibitors or ARBs and 15.2% of those not treated with these drugs had died. Multivariate analysis showed that the determinants of mortality were age (p = 0.0001), hypertension (p = 0.0120) and diabetes (p = 0.0129), whereas ACE inhibitors or ARBs had no effect on mortality. There was no significant difference between the patients treated with ACE inhibitors and those treated with ARBs.
The apparently increased mortality of patients with COVID-19 receiving long-term treatment with ACE inhibitors or ARBs is not due to the drugs themselves, but to the conditions associated with their use.
在 2019 年冠状病毒病（COVID-19）大流行开始时，有争议的数据报告称，血管紧张素转换酶（ACE）抑制剂和血管紧张素 II 受体阻滞剂（ARB）会使许多医生停止在 COVID-19 患者中使用它们。尽管大规模研究排除了这种担忧，但常见的经验是，服用 ACE 抑制剂或 ARB 的 COVID-19 患者死亡风险增加。本研究旨在探讨这种明显高死亡率的原因。
在大流行的第一波期间，我们对意大利北部受灾最严重的城市之一的一家医院的急诊科收治的 427 例连续 COVID-19 患者进行了现场研究，并在 30 天后进行了随访。根据临床，实验室和影像学数据将疾病定义为轻度，中度或重度，并使用多变量模型分析死亡率的决定因素。
在入院后 30 天内，接受 ACE 抑制剂或 ARB 治疗的患者中有 31.6％死亡，而未接受这些药物治疗的患者中有 15.2％死亡。多变量分析表明，死亡的决定因素是年龄（p=0.0001），高血压（p=0.0120）和糖尿病（p=0.0129），而 ACE 抑制剂或 ARB 对死亡率没有影响。接受 ACE 抑制剂治疗的患者与接受 ARB 治疗的患者之间没有显着差异。
长期接受 ACE 抑制剂或 ARB 治疗的 COVID-19 患者的死亡率似乎增加，这不是由于药物本身引起的，而是由于与药物使用相关的情况所致。
