Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.
Am J Hypertens. 2023 Jun 15;36(7):404-410. doi: 10.1093/ajh/hpad027.
In March and April 2020, medical societies published statements recommending continued use of renin-angiotensin system (RAS) inhibitors despite theoretical concerns that these medications could increase COVID-19 severity. Determining if patients discontinued RAS inhibitors during the COVID-19 pandemic could inform responses to future public health emergencies.
We analyzed claims data from US adults with health insurance in the Marketscan database. We identified patients who filled a RAS inhibitor and were persistent, defined by not having a ≥30-day gap without medication available, and high adherence, defined by having medication available on ≥80% of days, from March 2019 to February 2020. Among these patients, we estimated the proportion who discontinued their RAS inhibitor (i.e., had ≥30 consecutive days without a RAS inhibitor available to take) between March and August 2020. For comparison, we estimated the proportion of patients that discontinued a RAS inhibitor between March and August 2019 after being persistent with high adherence from March 2018 to February 2019.
Among 816,380 adults who were persistent and adherent to a RAS inhibitor from March 2019 to February 2020, 10.8% discontinued this medication between March and August 2020. Among 822,873 adults who were persistent and adherent to a RAS inhibitor from March 2018 to February 2019, 11.7% discontinued this medication between March and August 2019. The multivariable-adjusted relative risk for RAS inhibitor discontinuation in 2020 vs. 2019 was 0.94 (95% CI 0.93-0.95).
There was no evidence of an increase in RAS inhibitor discontinuation during the early stage of the COVID-19 pandemic.
2020 年 3 月和 4 月，医学协会发表声明，建议继续使用肾素-血管紧张素系统（RAS）抑制剂，尽管有理论认为这些药物可能会增加 COVID-19 的严重程度。确定患者在 COVID-19 大流行期间是否停止使用 RAS 抑制剂，可以为应对未来的公共卫生紧急情况提供信息。
我们分析了 Marketscan 数据库中美国有医疗保险的成年人的索赔数据。我们确定了在 2019 年 3 月至 2020 年 2 月期间，用 RAS 抑制剂且持续用药（定义为没有连续 30 天没有可用药物）和高依从性（定义为 80%以上的天数有药物可用）的患者。在这些患者中，我们估计了 2020 年 3 月至 8 月期间他们停止使用 RAS 抑制剂（即连续 30 天以上没有可用的 RAS 抑制剂可供服用）的比例。作为比较，我们估计了 2019 年 3 月至 8 月期间，在 2018 年 3 月至 2019 年 2 月持续高依从性的患者中，有多少人停止服用 RAS 抑制剂。
在 2019 年 3 月至 2020 年 2 月期间持续使用 RAS 抑制剂且依从性高的 816380 名成年人中，有 10.8%的人在 2020 年 3 月至 8 月期间停止了这种药物的使用。在 2018 年 3 月至 2019 年 2 月期间持续使用 RAS 抑制剂且依从性高的 822873 名成年人中，有 11.7%的人在 2019 年 3 月至 8 月期间停止了这种药物的使用。2020 年与 2019 年相比，RAS 抑制剂停药的多变量调整相对风险为 0.94（95%CI 0.93-0.95）。
在 COVID-19 大流行的早期阶段，没有证据表明 RAS 抑制剂的停药率增加。
