Chronic use of renin-angiotensin-aldosterone inhibitors in hypertensive COVID-19 patients : Results from a Spanish registry and meta-analysis
Copyright © 2021 Elsevier España, S.L.U. All rights reserved..
BACKGROUND: Hypertension is a prevalent condition among SARS-CoV-2 infected patients. Whether renin-angiotensin-aldosterone system (RAAS) inhibitors are beneficial or harmful is controversial.
METHODS: We have performed a national retrospective, nonexperimental comparative study from two tertiary hospitals to evaluate the impact of chronic use of RAAS inhibitors in hypertensive COVID-19 patients. A meta-analysis was performed to strengthen our findings.
RESULTS: Of 849 patients, 422 (49.7%) patients were hypertensive and 310 (73.5%) were taking RAAS inhibitors at baseline. Hypertensive patients were older, had more comorbidities, and a greater incidence of respiratory failure (-0.151 [95% CI -0.218, -0.084]). Overall mortality in hypertensive patients was 28.4%, but smaller among those with prescribed RAAS inhibitors before (-0.167 [95% CI -0.220, -0.114]) and during hospitalization (0.090 [-0.008,0.188]). Similar findings were observed after two propensity score matches that evaluated the benefit of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers among hypertensive patients. Multivariate logistic regression analysis of hypertensive patients found that age, diabetes mellitus, C-reactive protein, and renal failure were independently associated with all-cause mortality. On the contrary, ACEIs decreased the risk of death (OR 0.444 [95% CI 0.224-0.881]). Meta-analysis suggested a protective benefit of RAAS inhibitors (OR 0.6 [95% CI 0.42-0.8]) among hypertensive COVID-19.
CONCLUSION: Our data suggest that RAAS inhibitors may play a protective role in hypertensive COVID-19 patients. This finding was supported by a meta-analysis of the current evidence. Maintaining these medications during hospital stay may not negatively affect COVID-19 outcomes.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2022 |
|---|---|
| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:158 |
|---|---|
| Enthalten in: |
Medicina clinica - 158(2022), 7 vom: 08. Apr., Seite 315-323 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Aparisi, Álvaro [VerfasserIn] |
|---|
| Links: |
|---|
| Anmerkungen: |
Date Completed 18.04.2022 Date Revised 17.12.2022 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1016/j.medcli.2021.04.005 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM326367799 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM326367799 | ||
| 003 | DE-627 | ||
| 005 | 20231225194436.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2022 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.medcli.2021.04.005 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1087.xml |
| 035 | |a (DE-627)NLM326367799 | ||
| 035 | |a (NLM)34088524 | ||
| 035 | |a (PII)S0025-7753(21)00209-8 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Aparisi, Álvaro |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Chronic use of renin-angiotensin-aldosterone inhibitors in hypertensive COVID-19 patients |b Results from a Spanish registry and meta-analysis |
| 264 | 1 | |c 2022 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 18.04.2022 | ||
| 500 | |a Date Revised 17.12.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2021 Elsevier España, S.L.U. All rights reserved. | ||
| 520 | |a BACKGROUND: Hypertension is a prevalent condition among SARS-CoV-2 infected patients. Whether renin-angiotensin-aldosterone system (RAAS) inhibitors are beneficial or harmful is controversial | ||
| 520 | |a METHODS: We have performed a national retrospective, nonexperimental comparative study from two tertiary hospitals to evaluate the impact of chronic use of RAAS inhibitors in hypertensive COVID-19 patients. A meta-analysis was performed to strengthen our findings | ||
| 520 | |a RESULTS: Of 849 patients, 422 (49.7%) patients were hypertensive and 310 (73.5%) were taking RAAS inhibitors at baseline. Hypertensive patients were older, had more comorbidities, and a greater incidence of respiratory failure (-0.151 [95% CI -0.218, -0.084]). Overall mortality in hypertensive patients was 28.4%, but smaller among those with prescribed RAAS inhibitors before (-0.167 [95% CI -0.220, -0.114]) and during hospitalization (0.090 [-0.008,0.188]). Similar findings were observed after two propensity score matches that evaluated the benefit of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers among hypertensive patients. Multivariate logistic regression analysis of hypertensive patients found that age, diabetes mellitus, C-reactive protein, and renal failure were independently associated with all-cause mortality. On the contrary, ACEIs decreased the risk of death (OR 0.444 [95% CI 0.224-0.881]). Meta-analysis suggested a protective benefit of RAAS inhibitors (OR 0.6 [95% CI 0.42-0.8]) among hypertensive COVID-19 | ||
| 520 | |a CONCLUSION: Our data suggest that RAAS inhibitors may play a protective role in hypertensive COVID-19 patients. This finding was supported by a meta-analysis of the current evidence. Maintaining these medications during hospital stay may not negatively affect COVID-19 outcomes | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Meta-Analysis | |
| 650 | 4 | |a Angiotensin II receptor blockers | |
| 650 | 4 | |a Angiotensin-converting-enzyme inhibitors | |
| 650 | 4 | |a Antagonistas de los receptores de la angiotensina II | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Hipertensión arterial | |
| 650 | 4 | |a Hypertension | |
| 650 | 4 | |a Inhibidores de la enzima convertidora de angiotensina | |
| 650 | 4 | |a Meta-analysis | |
| 650 | 4 | |a Metaanális | |
| 650 | 4 | |a SARS-CoV-2 | |
| 650 | 7 | |a Angiotensin Receptor Antagonists |2 NLM | |
| 650 | 7 | |a Angiotensins |2 NLM | |
| 650 | 7 | |a Antihypertensive Agents |2 NLM | |
| 650 | 7 | |a Mineralocorticoid Receptor Antagonists |2 NLM | |
| 650 | 7 | |a Aldosterone |2 NLM | |
| 650 | 7 | |a 4964P6T9RB |2 NLM | |
| 650 | 7 | |a Renin |2 NLM | |
| 650 | 7 | |a EC 3.4.23.15 |2 NLM | |
| 700 | 1 | |a Catalá, Pablo |e verfasserin |4 aut | |
| 700 | 1 | |a Amat-Santos, Ignacio J |e verfasserin |4 aut | |
| 700 | 1 | |a Marcos-Mangas, Marta |e verfasserin |4 aut | |
| 700 | 1 | |a López-Otero, Diego |e verfasserin |4 aut | |
| 700 | 1 | |a Veras, Carlos |e verfasserin |4 aut | |
| 700 | 1 | |a López-Pais, Javier |e verfasserin |4 aut | |
| 700 | 1 | |a Cabezón-Villalba, Gonzalo |e verfasserin |4 aut | |
| 700 | 1 | |a Cacho Antonio, Carla Eugenia |e verfasserin |4 aut | |
| 700 | 1 | |a Candela, Jordi |e verfasserin |4 aut | |
| 700 | 1 | |a Antúnez-Muiños, Pablo |e verfasserin |4 aut | |
| 700 | 1 | |a Gil, José Francisco |e verfasserin |4 aut | |
| 700 | 1 | |a González Ferrero, Teba |e verfasserin |4 aut | |
| 700 | 1 | |a Rojas, Gino |e verfasserin |4 aut | |
| 700 | 1 | |a Pérez-Poza, Marta |e verfasserin |4 aut | |
| 700 | 1 | |a Uribarri, Aitor |e verfasserin |4 aut | |
| 700 | 1 | |a Otero-García, Oscar |e verfasserin |4 aut | |
| 700 | 1 | |a García-Granja, Pablo Elpidio |e verfasserin |4 aut | |
| 700 | 1 | |a Jiménez Ramos, Víctor |e verfasserin |4 aut | |
| 700 | 1 | |a Revilla, Ana |e verfasserin |4 aut | |
| 700 | 1 | |a Dueñas, Carlos |e verfasserin |4 aut | |
| 700 | 1 | |a Gómez, Itzíar |e verfasserin |4 aut | |
| 700 | 1 | |a González-Juanatey, José Ramón |e verfasserin |4 aut | |
| 700 | 1 | |a San Román, J Alberto |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Medicina clinica |d 1948 |g 158(2022), 7 vom: 08. Apr., Seite 315-323 |w (DE-627)NLM000359017 |x 1578-8989 |7 nnns |
| 773 | 1 | 8 | |g volume:158 |g year:2022 |g number:7 |g day:08 |g month:04 |g pages:315-323 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.medcli.2021.04.005 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 158 |j 2022 |e 7 |b 08 |c 04 |h 315-323 | ||