肾素-血管紧张素系统阻滞剂与因COVID-19住院的高血压患者的死亡风险：一项意大利登记研究。
Renin Angiotensin System Blockers and Risk of Mortality in Hypertensive Patients Hospitalized for COVID-19: An Italian Registry.
作者信息
Angeli Fabio, Verdecchia Paolo, Balestrino Antonella, Bruschi Claudio, Ceriana Piero, Chiovato Luca, Dalla Vecchia Laura Adelaide, Fanfulla Francesco, La Rovere Maria Teresa, Perego Francesca, Scalvini Simonetta, Spanevello Antonio, Traversi Egidio, Visca Dina, Vitacca Michele, Bachetti Tiziana
机构信息
Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy.
Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 21049 Tradate, Italy.
出版信息
J Cardiovasc Dev Dis. 2022 Jan 6;9(1):15. doi: 10.3390/jcdd9010015.
BACKGROUND
It is uncertain whether exposure to renin-angiotensin system (RAS) modifiers affects the severity of the new coronavirus disease 2019 (COVID-19) because most of the available studies are retrospective.
METHODS
We tested the prognostic value of exposure to RAS modifiers (either angiotensin-converting enzyme inhibitors [ACE-Is] or angiotensin receptor blockers [ARBs]) in a prospective study of hypertensive patients with COVID-19. We analyzed data from 566 patients (mean age 75 years, 54% males, 162 ACE-Is users, and 147 ARBs users) hospitalized in five Italian hospitals. The study used systematic prospective data collection according to a pre-specified protocol. All-cause mortality during hospitalization was the primary outcome.
RESULTS
Sixty-six patients died during hospitalization. Exposure to RAS modifiers was associated with a significant reduction in the risk of in-hospital mortality when compared to other BP-lowering strategies (odds ratio [OR]: 0.54, 95% confidence interval [CI]: 0.32 to 0.90, = 0.019). Exposure to ACE-Is was not significantly associated with a reduced risk of in-hospital mortality when compared with patients not treated with RAS modifiers (OR: 0.66, 95% CI: 0.36 to 1.20, = 0.172). Conversely, ARBs users showed a 59% lower risk of death (OR: 0.41, 95% CI: 0.20 to 0.84, = 0.016) even after allowance for several prognostic markers, including age, oxygen saturation, occurrence of severe hypotension during hospitalization, and lymphocyte count (adjusted OR: 0.37, 95% CI: 0.17 to 0.80, = 0.012). The discontinuation of RAS modifiers during hospitalization did not exert a significant effect ( = 0.515).
CONCLUSIONS
This prospective study indicates that exposure to ARBs reduces mortality in hospitalized patients with COVID-19.
背景
由于大多数现有研究都是回顾性的，因此暴露于肾素 - 血管紧张素系统（RAS）调节剂是否会影响2019年新型冠状病毒病（COVID - 19）的严重程度尚不确定。
方法
在一项针对COVID - 19高血压患者的前瞻性研究中，我们测试了暴露于RAS调节剂（血管紧张素转换酶抑制剂[ACE - Is]或血管紧张素受体阻滞剂[ARBs]）的预后价值。我们分析了意大利五家医院收治的566例患者的数据（平均年龄75岁，54%为男性，162例使用ACE - Is，147例使用ARBs）。该研究根据预先指定的方案进行系统的前瞻性数据收集。住院期间的全因死亡率是主要结局。
结果
66例患者在住院期间死亡。与其他降压策略相比，暴露于RAS调节剂与住院死亡率风险显著降低相关（比值比[OR]：0.54，95%置信区间[CI]：0.32至0.90，P = 0.019）。与未接受RAS调节剂治疗的患者相比，暴露于ACE - Is与住院死亡率降低风险无显著相关性（OR：0.66，95% CI：0.36至1.20，P = 0.172）。相反，即使在考虑了几个预后指标，包括年龄、血氧饱和度、住院期间严重低血压的发生情况和淋巴细胞计数后，ARBs使用者的死亡风险仍降低了59%（OR：0.41，95% CI：0.20至0.84，P = 0.016）（调整后的OR：0.37，95% CI：0.17至0.80，P = 0.012）。住院期间停用RAS调节剂未产生显著影响（P = 0.515）。
结论
这项前瞻性研究表明，暴露于ARBs可降低COVID - 19住院患者的死亡率。
Zotero 插件