COVID-19 与动脉高血压的影响——国际 HOPE COVID-19 登记研究（意大利-西班牙-德国）分析。
COVID-19 and the impact of arterial hypertension-An analysis of the international HOPE COVID-19 Registry (Italy-Spain-Germany).
机构信息
University of Mannheim, Mannheim, Germany.
Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC, ), Universidad Complutense de Madrid, Madrid, Spain.
出版信息
Eur J Clin Invest. 2021 Nov;51(11):e13582. doi: 10.1111/eci.13582. Epub 2021 Aug 19.
BACKGROUND
A systematic analysis of concomitant arterial hypertension in COVID-19 patients and the impact of angiotensin-converting-enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARBs) have not been studied in a large multicentre cohort yet. We conducted a subanalysis from the international HOPE Registry (https://hopeprojectmd.com, NCT04334291) comparing COVID-19 in presence and absence of arterial hypertension.
MATERIALS AND METHODS
Out of 5837 COVID-19 patients, 2850 (48.8%) patients had the diagnosis arterial hypertension. 1978/2813 (70.3%) patients were already treated with ACEI or ARBs. The clinical outcome of the present subanalysis included all-cause mortality over 40 days of follow-up.
RESULTS
Patients with arterial hypertension suffered significantly more from different complications including respiratory insufficiency (60.8% vs 39.5%), heart failure (9.9% vs 3.1%), acute kidney injury (25.3% vs 7.3%), pneumonia (90.6% vs 86%), sepsis (14.7% vs 7.5%), and bleeding events (3.6% vs 1.6%). The mortality rate was 29.6% in patients with concomitant arterial hypertension and 11.3% without arterial hypertension (P < .001). Invasive and non-invasive respiratory supports were significantly more required in presence of arterial hypertension as compared without it. In the multivariate cox regression analysis, while age≥65, benzodiazepine, antidepressant at admission, elevated LDH or creatinine, respiratory insufficiency and sepsis might be a positive independent predictors of mortality, antiviral drugs, interferon treatment, ACEI or ARBs at discharge or oral anticoagulation at discharge might be an independent negative predictor of the mortality.
CONCLUSIONS
The mortality rate and in-hospital complications might be increased in COVID-19 patients with a concomitant history of arterial hypertension. The history of ACEI or ARBs treatments does not seem to impact the outcome of these patients.
背景
目前尚未在大型多中心队列中对伴有动脉高血压的 COVID-19 患者进行系统性分析，也未研究血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）的影响。我们对国际 HOPE 登记处（https://hopeprojectmd.com，NCT04334291）进行了一项亚分析，比较了存在和不存在动脉高血压的 COVID-19 患者。
材料和方法
在 5837 例 COVID-19 患者中，2850 例（48.8%）患者诊断为动脉高血压。2813 例中有 1978 例（70.3%）患者已接受 ACEI 或 ARB 治疗。本次亚分析的临床结局包括 40 天随访期间的全因死亡率。
结果
患有动脉高血压的患者出现各种并发症的比例显著更高，包括呼吸功能不全（60.8% vs 39.5%）、心力衰竭（9.9% vs 3.1%）、急性肾损伤（25.3% vs 7.3%）、肺炎（90.6% vs 86%）、败血症（14.7% vs 7.5%）和出血事件（3.6% vs 1.6%）。伴有动脉高血压的患者死亡率为 29.6%，无动脉高血压的患者死亡率为 11.3%（P<.001）。与无动脉高血压患者相比，有动脉高血压患者更需要进行有创和无创呼吸支持。多变量 Cox 回归分析显示，年龄≥65 岁、入院时使用苯二氮䓬类药物、抗抑郁药、LDH 或肌酐升高、呼吸功能不全和败血症可能是死亡的阳性独立预测因素，抗病毒药物、干扰素治疗、出院时使用 ACEI 或 ARB 或出院时使用口服抗凝剂可能是死亡的独立阴性预测因素。
结论
伴有动脉高血压病史的 COVID-19 患者死亡率和住院并发症可能增加。ACEI 或 ARB 治疗史似乎不会影响这些患者的结局。
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