Association of Inpatient Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Mortality Among Patients With Hypertension Hospitalized With COVID-19
机构：[1]Cardiology Renmin Hospital of Wuhan University[2]Medical Science Research Center Zhongnan Hospital of Wuhan University[3]Institute of Model Animal of Wuhan University[4]Basic Medical School, Wuhan University[5]Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China[6]Anesthesiology, Cardiovascular Research Laboratories, David Geffen School of Medicine, University of California, Los Angeles[7]Centre for Clinic Pharmacology, The William Harvey Research Institute, Queen Mary University of London, United Kingdom[8]Wuhan Kanghuashuhai Technology Company Wuhan[9]Urology Wuhan Third Hospital & Tongren Hospital of Wuhan University[10]Wuhan Ninth Hospital[11]Cardiology, The Central Hospital of Wuhan[12]Cardiovascular Surgery, Union Hospital Tongji Medical College, Huazhong University of Science and Technology华中科技大学同济医学院附属协和医院[13]Stomatology, Xiantao First People’s Hospital[14]General Surgery, Huanggang Central Hospital, Wuhan, China[15]General Surgery, Ezhou Central Hospital[16]Infections Department, Wuhan Seventh Hospital[17]Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, United Kingdom[18]NAFLD Research Center, Division of Gastroenterology and Epidemiology, University of California San Diego, CA[19]and Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada[20]Eye Center Renmin Hospital of Wuhan University[21]Neonatology Renmin Hospital of Wuhan University[22]Hepatobiliary and Pancreatic Surgery Zhongnan Hospital of Wuhan University[23]Cardiology Zhongnan Hospital of Wuhan University[24]Gastroenterology Zhongnan Hospital of Wuhan University[25]Center for Evidence-Based and Translational Medicine Zhongnan Hospital of Wuhan University[26]Urology Zhongnan Hospital of Wuhan University[27]Intensive Care Unit Wuhan Third Hospital & Tongren Hospital of Wuhan University[28]Gastroenterology Wuhan Third Hospital & Tongren Hospital of Wuhan University
Rationale: Use of ACEIs (angiotensin-converting enzyme inhibitors) and ARBs (angiotensin II receptor blockers) is a major concern for clinicians treating coronavirus disease 2019 (COVID-19) in patients with hypertension. Objective: To determine the association between in-hospital use of ACEI/ARB and all-cause mortality in patients with hypertension and hospitalized due to COVID-19. Methods and Results: This retrospective, multi-center study included 1128 adult patients with hypertension diagnosed with COVID-19, including 188 taking ACEI/ARB (ACEI/ARB group; median age 64 [interquartile range, 55-68] years; 53.2% men) and 940 without using ACEI/ARB (non-ACEI/ARB group; median age 64 [interquartile range 57-69]; 53.5% men), who were admitted to 9 hospitals in Hubei Province, China from December 31, 2019 to February 20, 2020. In mixed-effect Cox model treating site as a random effect, after adjusting for age, gender, comorbidities, and in-hospital medications, the detected risk for all-cause mortality was lower in the ACEI/ARB group versus the non-ACEI/ARB group (adjusted hazard ratio, 0.42 [95% CI, 0.19-0.92];P=0.03). In a propensity score-matched analysis followed by adjusting imbalanced variables in mixed-effect Cox model, the results consistently demonstrated lower risk of COVID-19 mortality in patients who received ACEI/ARB versus those who did not receive ACEI/ARB (adjusted hazard ratio, 0.37 [95% CI, 0.15-0.89];P=0.03). Further subgroup propensity score-matched analysis indicated that, compared with use of other antihypertensive drugs, ACEI/ARB was also associated with decreased mortality (adjusted hazard ratio, 0.30 [95% CI, 0.12-0.70];P=0.01) in patients with COVID-19 and coexisting hypertension. Conclusions: Among hospitalized patients with COVID-19 and coexisting hypertension, inpatient use of ACEI/ARB was associated with lower risk of all-cause mortality compared with ACEI/ARB nonusers. While study interpretation needs to consider the potential for residual confounders, it is unlikely that in-hospital use of ACEI/ARB was associated with an increased mortality risk.
基金：
National Key R&D Program of China (2016YFF0101504, 2020YFC0845500), the National Science Foundation of China (81630011, 81970364, 81970070, 81970011, 81870171, and 81700356), the Major Research Plan of the National Natural Science Foundation of China (91639304), the Hubei Science and Technology Support Project(2019BFC582, 2018BEC473, and 2017BEC001), and Medical flight plan of Wuhan University.
第一作者机构：[1]Cardiology Renmin Hospital of Wuhan University[2]Medical Science Research Center Zhongnan Hospital of Wuhan University[3]Institute of Model Animal of Wuhan University[4]Basic Medical School, Wuhan University
共同第一作者：
通讯作者：
通讯机构：[1]Cardiology Renmin Hospital of Wuhan University[2]Medical Science Research Center Zhongnan Hospital of Wuhan University[3]Institute of Model Animal of Wuhan University[4]Basic Medical School, Wuhan University[18]NAFLD Research Center, Division of Gastroenterology and Epidemiology, University of California San Diego, CA[19]and Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada[22]Hepatobiliary and Pancreatic Surgery Zhongnan Hospital of Wuhan University[*1]Cardiology, Renmin Hospital of Wuhan University, 99 Zhangzhidong Rd, Wuhan 430060, China[*2]Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada[*3]Division of Gastroenterology and Epidemiology, University of California at San Diego[*4]Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University,
推荐引用方式(GB/T 7714)：
Peng Zhang,Lihua Zhu,Jingjing Cai,et al.Association of Inpatient Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Mortality Among Patients With Hypertension Hospitalized With COVID-19[J].CIRCULATION RESEARCH.2020,126(12):1671-1681.doi:10.1161/CIRCRESAHA.120.317134.
APA：
Peng Zhang,Lihua Zhu,Jingjing Cai,Fang Lei,Juan-Juan Qin...&Hongliang Li.(2020).Association of Inpatient Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Mortality Among Patients With Hypertension Hospitalized With COVID-19.CIRCULATION RESEARCH,126,(12)
MLA：
Peng Zhang,et al."Association of Inpatient Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Mortality Among Patients With Hypertension Hospitalized With COVID-19".CIRCULATION RESEARCH 126..12(2020):1671-1681
医学