门诊使用肾素-血管紧张素-醛固酮系统阻滞剂与 COVID-19 大流行期间急性呼吸道疾病结局的关联：一项队列研究。
Association of outpatient use of renin-angiotensin-aldosterone system blockers on outcomes of acute respiratory illness during the COVID-19 pandemic: a cohort study.
机构信息
Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
Visiting Fellow, OptumLabs, Eden Prairie, Minnesota, USA.
出版信息
BMJ Open. 2022 Jul 6;12(7):e060305. doi: 10.1136/bmjopen-2021-060305.
OBJECTIVES
Evaluate the associations between patients taking ACE inhibitors and angiotensin receptor blockers (ARBs) and their clinical outcomes after an acute viral respiratory illness (AVRI) due to COVID-19.
DESIGN
Retrospective cohort.
SETTING
The USA; 2017-2018 influenza season, 2018-2019 influenza season, and 2019-2020 influenza/COVID-19 season.
PARTICIPANTS
People with hypertension (HTN) taking an ACEi, ARB or other HTN medications, and experiencing AVRI.
MAIN OUTCOME MEASURES
Change in hospital admission, intensive care unit (ICU) or coronary care unit (CCU), acute respiratory distress (ARD), ARD syndrome (ARDS) and all-cause mortality, comparing COVID-19 to pre-COVID-19 influenza seasons.
RESULTS
The cohort included 1 059 474 episodes of AVRI (653 797 filled an ACEi or ARB, and 405 677 other HTN medications). 58.6% were women and 72.9% with age ≥65. The ACEi/ARB cohort saw a larger increase in risk in the COVID-19 influenza season than the other HTN medication cohort for four out of five outcomes, with an additional 1.5 percentage point (pp) increase in risk of an inpatient stay (95% CI 1.2 to 1.9 pp) and of ICU/CCU use (95% CI 0.3 to 2.7 pp) as well as a 0.7 pp (0.1 to 1.2 pp) additional increase in risk of ARD and 0.9 pp (0.4 to 1.3 pp) additional increase in risk of ARDS. There was no statistically significant difference in the absolute risk of death (-0.2 pp, 95% CI -0.4 to 0.1 pp). However, the relative risk of death in 2019/2020 versus 2017/2018 for the ACEi/ARB group was larger (1.40 (1.36 to 1.44)) than for the other HTN medication cohort (1.24 (1.21 to 1.28)).
CONCLUSIONS
People with AVRI using ACEi/ARBs for HTN had a greater increase in poor outcomes during the COVID-19 pandemic than those using other medications to treat HTN. The small absolute magnitude of the differences likely does not support changes in clinical practice.
目的
评估 COVID-19 急性病毒性呼吸道感染 (AVRI) 后服用血管紧张素转换酶抑制剂 (ACEI) 和血管紧张素受体阻滞剂 (ARB) 的患者与临床结局之间的关联。
设计
回顾性队列研究。
地点
美国；2017-2018 年流感季节、2018-2019 年流感季节和 2019-2020 年流感/COVID-19 季节。
参与者
患有高血压 (HTN) 并服用 ACEi、ARB 或其他 HTN 药物且经历 AVRI 的人群。
主要观察指标
与 COVID-19 前流感季节相比，比较 COVID-19 与 COVID-19 前流感季节相比，住院、重症监护病房 (ICU) 或冠心病监护病房 (CCU)、急性呼吸窘迫 (ARD)、ARDS 综合征和全因死亡率的变化。
结果
该队列包括 1059474 例 AVRI 发作（653797 例服用 ACEi 或 ARB，405677 例服用其他 HTN 药物）。58.6%为女性，72.9%年龄≥65 岁。ACEi/ARB 队列在 COVID-19 流感季节的五个结局中有四个的风险增加幅度大于其他 HTN 药物队列，住院风险增加 1.5 个百分点（95%CI 1.2 至 1.9 个百分点）和 ICU/CCU 使用率增加 0.3 个百分点（95%CI 0.3 至 2.7 个百分点），ARD 风险增加 0.7 个百分点（0.1 至 1.2 个百分点），ARDS 风险增加 0.9 个百分点（0.4 至 1.3 个百分点）。死亡的绝对风险无统计学显著差异（-0.2 个百分点，95%CI-0.4 至 0.1 个百分点）。然而，ACEi/ARB 组 2019/2020 年与 2017/2018 年相比的死亡相对风险更大（1.40（1.36 至 1.44）），大于其他 HTN 药物队列（1.24（1.21 至 1.28））。
结论
患有 AVRI 且使用 ACEi/ARB 治疗 HTN 的患者在 COVID-19 大流行期间不良结局的增加幅度大于使用其他药物治疗 HTN 的患者。差异的绝对幅度较小，不太可能支持临床实践的改变。
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