Department of Anesthesiology and Perioperative medicine, Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Clinical Research Center for Anesthesiology and Perioperative Medicine, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, 200434, China.
Department of Military Health Statistics, Naval Medical University, Shanghai, 200433, China.
BMC Infect Dis. 2023 Dec 18;23(1):882. doi: 10.1186/s12879-023-08913-6.
To explore the effects of long-term oral ACEIs/ARBs on the incidence of exacerbation and in-hospital mortality in elderly COVID-19 Omicron BA.2 patients with hypertension, especially patients aged 80 years or older.
In this retrospective study, patients suffering mild and rcommon COVID-19 with hypertension who were hospitalized in the Shanghai Fourth People's Hospital between April 2022 and June 2022 were enrolled. Primary outcomes included the incidence of exacerbation and in-hospital mortality. Secondary outcomes included the incidence of respiratory failure of patients, use of mechanical ventilation, nucleic acid conversion time (NCT), hospitalization costs, and the temporal trend of the incidence of exacerbations and in-hospital mortality in different age groups. The data were analysed using propensity score weighting (PSW).
In the entire cohort, there were 298 ACEI/ARB users and 465 non-ACEI/ARB users. The ACEI/ARB group showed a lower incidence of exacerbation (OR = 0.64, 95% CI for OR: 0.46-0.89, P = 0.0082) and lower in-hospital mortality (OR = 0.49, 95% CI for OR: 0.27-0.89, P = 0.0201) after PSW. Sensitivity analysis obtained the same results. The results of the subgroup of patients aged 80 years and older obtained a similar conclusion as the whole cohort. Most of the study indicators did not differ statistically significantly in the subgroup of patients aged 60 to 79 years except for rates of mechanical ventilation and respiratory failure.
Antihypertensive therapy with ACEIs/ARBs might reduce the incidence of exacerbation and in-hospital mortality. The findings of this study support the use of ACEIs/ARBs in COVID-19 patients infected by Omicron BA.2, especially in patients aged 80 years or older with hypertension.
探讨长期口服 ACEI/ARB 对合并高血压的老年 COVID-19 奥密克戎 BA.2 患者恶化发生率和住院病死率的影响，尤其针对 80 岁及以上患者。
本回顾性研究纳入 2022 年 4 月至 6 月在上海市第四人民医院因 COVID-19 住院且合并高血压的轻症及普通型患者。主要结局包括恶化发生率和住院病死率。次要结局包括患者呼吸衰竭发生率、机械通气使用率、核酸转阴时间（NCT）、住院费用以及不同年龄组恶化发生率和住院病死率的时间趋势。采用倾向评分匹配（PSM）进行数据分析。
在全队列中，有 298 例 ACEI/ARB 使用者和 465 例非 ACEI/ARB 使用者。PSM 后 ACEI/ARB 组恶化发生率（OR=0.64，95%CI 为 0.460.89，P=0.0082）和住院病死率（OR=0.49，95%CI 为 0.270.89，P=0.0201）均较低。敏感性分析也得到了相同的结果。在 80 岁及以上亚组中也得到了与全队列相似的结论。在 60~79 岁亚组中，除机械通气率和呼吸衰竭率外，大多数研究指标的统计学差异均不显著。
ACEI/ARB 降压治疗可能降低恶化发生率和住院病死率。本研究结果支持在感染奥密克戎 BA.2 的 COVID-19 患者中使用 ACEI/ARB，尤其是合并高血压的 80 岁及以上患者。
