接受肾素-血管紧张素-醛固酮系统抑制剂治疗高血压的医疗保险受益人群中，与新冠病毒病相关的住院风险及更严重后果

Risk of Covid-19-Related Hospitalization and More Severe Outcomes in Medicare Beneficiaries Treated with Renin-Angiotensin-Aldosterone System Inhibitors for Hypertension.

作者信息

Graham David J, Izurieta Hector S, Muthuri Stella G, Zhang Di, Sandhu Alexander T, Lu Yun, Zhao Yueqin, Feng Yuhui, Eworuke Efe, Lyu Hai, Gandotra Charu, Smith Elizabeth R, Avagyan Armen, Wernecke Michael, Kelman Jeffrey A, Forshee Richard A, MaCurdy Thomas E

机构信息

Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, 10903 New Hampshire Ave, Building 22, Room 4314, Silver Spring, MD, 20993, USA.

Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.

出版信息

J Gen Intern Med. 2021 Dec;36(12):3802-3809. doi: 10.1007/s11606-021-07155-z. Epub 2021 Oct 1.

DOI:10.1007/s11606-021-07155-z

PMID:34599472

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8486159/

Abstract

BACKGROUND

There are theoretical concerns that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) could increase the risk of severe Covid-19.

OBJECTIVE

To determine if ACEIs and ARBs are associated with an increased risk of Covid-19 hospitalization overall, or hospitalization involving intensive care unit (ICU) admission, invasive mechanical ventilation, or death.

DESIGN

Observational case-control study.

PARTICIPANTS

Medicare beneficiaries aged ≥ 66 years with hypertension, treated with ACEIs, ARBs, calcium channel blockers (CCBs), or thiazide diuretics.

MAIN MEASURES

Adjusted odds ratios (OR) and 95% confidence intervals (CI) for the outcomes of Covid-19 hospitalization, or hospitalization involving ICU admission, invasive mechanical ventilation, or death.

RESULTS

A total of 35,300 cases of hospitalized Covid-19 were matched to 228,228 controls on calendar date and neighborhood of residence. The median age of cases was 79 years, 57.4% were female, and the median duration of hospitalization was 8 days (interquartile range 5-12). ACEIs and ARBs were associated with a slight reduction in Covid-19 hospitalization risk compared with treatment with other first-line antihypertensives (OR for ACEIs 0.95, 95% CI 0.92-0.98; OR for ARBs 0.94, 95% CI 0.90-0.97). Similar results were obtained for hospitalizations involving ICU admission, invasive mechanical ventilation, or death. There were no meaningful differences in risk for ACEIs compared with ARBs. In an analysis restricted to monotherapy with a first-line agent, CCBs were associated with a small increased risk of Covid-19 hospitalization compared with ACEIs (OR 1.09, 95% CI 1.04-1.14), ARBs (OR 1.10, 95% CI 1.05-1.15), or thiazide diuretics (OR 1.11, 95% CI 1.03-1.19).

CONCLUSIONS

ACEIs and ARBs were not associated with an increased risk of Covid-19 hospitalization or with hospitalization involving ICU admission, invasive mechanical ventilation, or death. The finding of a small increased risk of Covid-19 hospitalization with CCBs was unexpected and could be due to residual confounding.

摘要

背景

理论上担心血管紧张素转换酶抑制剂（ACEIs）和血管紧张素受体阻滞剂（ARBs）可能会增加患重症新型冠状病毒肺炎（Covid-19）的风险。

目的

确定ACEIs和ARBs是否与Covid-19总体住院风险增加相关，或与涉及重症监护病房（ICU）收治、有创机械通气或死亡的住院情况相关。

设计

观察性病例对照研究。

参与者

年龄≥66岁、患有高血压且接受ACEIs、ARBs、钙通道阻滞剂（CCBs）或噻嗪类利尿剂治疗的医疗保险受益人。

主要测量指标

Covid-19住院、或涉及ICU收治、有创机械通气或死亡结局的校正比值比（OR）和95%置信区间（CI）。

结果

总共35300例Covid-19住院病例与228228名对照按日历日期和居住社区进行匹配。病例的中位年龄为79岁，57.4%为女性，中位住院时间为8天（四分位间距5 - 12天）。与使用其他一线抗高血压药物治疗相比，ACEIs和ARBs与Covid-19住院风险略有降低相关（ACEIs的OR为0.95，95%CI为0.92 - 0.98；ARBs的OR为0.94，95%CI为0.90 - 0.97）。对于涉及ICU收治、有创机械通气或死亡的住院情况，也获得了类似结果。ACEIs与ARBs相比，风险无显著差异。在一项仅限于一线药物单药治疗的分析中，与ACEIs（OR 1.09, 95%CI 1.04 - 1.14）、ARBs（OR 1.10, 95%CI 1.05 - 1.15）或噻嗪类利尿剂（OR 1.11, 95%CI 1.03 - 1.19）相比，CCBs与Covid-19住院风险略有增加相关。