Departments of Medicine; and.
Cardiology, University of Miami/JFK Medical Center Palm Beach Regional GME Consortium, Atlantis, FL.
J Cardiovasc Pharmacol. 2022 Mar 1;79(3):311-314. doi: 10.1097/FJC.0000000000001189.
Early during the Coronavirus disease 2019 (Covid-19) pandemic, concerns were raised regarding potential adverse outcomes in patients taking angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs). These concerns were based on animal studies showing increased ACE-2 expression in mice treated with ACEI/ARB. This is a single-center, retrospective, cohort study of 289 patients diagnosed with 2019 Novel Coronavirus (SARS-CoV-2) hospitalized between March of 2020 and June of 2020. The study was intended to investigate the impact of ACEIs and/or ARBs on in-hospital mortality, intensive care unit (ICU) admission, postadmission hemodialysis requirement, and the need for mechanical ventilation in patients with COVID-19. This cohort of 289 patients included 139 of 289 women (48%) with a mean age of 61 ± 19 years. Patients using ACEIs/ARBs were older (69.68 vs. 57.9 years; P < 0.0001), more likely to have a history of hypertension (97% vs. 36%; P < 0.0001), diabetes mellitus (48% vs. 20.9%; P < 0.0001), chronic heart failure (11.39% vs. 4.29%; P < 0.0512), coronary artery disease (20.25% vs. 7.14%; P < 0.0025), stroke/Transient Ischemic Attack (7.59% vs. 2.38%; P < 0.0761), chronic kidney disease (11.39% vs. 3.33%; P < 0.0167), atrial fibrillation/flutter (18.99% vs. 7.14%; P < 0.0080), and dementia (22.7% vs. 11.4%; P < 0.0233) compared with the nonuser group. There was significantly higher in-hospital mortality in patients using ACEIs/ARBs than nonusers, respectively (32.9% vs. 15.2%; P < 0.0015). However, a multivariate logistics regression analysis performed to adjust for common confounders demonstrated no significant difference in all-cause in-patient mortality (P 0.7141). Admission to ICU, postadmission hemodialysis requirement, and mechanical ventilation showed no significant differences between the 2 groups (P = NS). This study suggests that the use of ACEIs and ARBs in patients with COVID-19 was not found to significantly increase all-cause in-hospital mortality, ICU admissions, and hemodialysis and mechanical ventilation requirements.
在 2019 年冠状病毒病（COVID-19）大流行早期，人们对服用血管紧张素转换酶抑制剂（ACEI）/血管紧张素受体阻滞剂（ARB）的患者可能出现不良结局表示担忧。这些担忧基于动物研究表明，用 ACEI/ARB 治疗的小鼠 ACE-2 表达增加。这是一项单中心、回顾性队列研究，纳入了 2020 年 3 月至 6 月期间住院的 289 名确诊为 2019 年新型冠状病毒（SARS-CoV-2）的患者。该研究旨在调查 ACEI 和/或 ARB 对 COVID-19 患者住院死亡率、重症监护病房（ICU）入院、住院后血液透析需求以及机械通气需求的影响。这 289 名患者中包括 139 名（48%）女性，平均年龄为 61 ± 19 岁。使用 ACEI/ARB 的患者年龄更大（69.68 岁 vs. 57.9 岁；P < 0.0001），更有可能患有高血压（97% vs. 36%；P < 0.0001）、糖尿病（48% vs. 20.9%；P < 0.0001）、慢性心力衰竭（11.39% vs. 4.29%；P < 0.0512）、冠心病（20.25% vs. 7.14%；P < 0.0025）、中风/短暂性脑缺血发作（7.59% vs. 2.38%；P < 0.0761）、慢性肾脏病（11.39% vs. 3.33%；P < 0.0167）、心房颤动/扑动（18.99% vs. 7.14%；P < 0.0080）和痴呆（22.7% vs. 11.4%；P < 0.0233）。与非使用者相比，使用 ACEI/ARB 的患者住院死亡率显著更高，分别为（32.9% vs. 15.2%；P < 0.0015）。然而，为调整常见混杂因素而进行的多变量逻辑回归分析表明，两组之间的全因住院死亡率无显著差异（P = 0.7141）。两组 ICU 入院、住院后血液透析需求和机械通气均无显著差异（P = NS）。本研究表明，COVID-19 患者使用 ACEI 和 ARB 并未显著增加全因住院死亡率、ICU 入院率以及血液透析和机械通气需求。
