Use of Renin-Angiotensin-Aldosterone System Inhibitors and Severe COVID-19 Outcomes in Patients with Hypertension: A Nationwide Cohort Study

Autor: Jae Hyun Bae, Nam Hoon Kim, Sun Kyu Choi, Sin Gon Kim, Juneyoung Lee
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Male
medicine.medical_specialty
hypertension
Endocrinology
Diabetes and Metabolism
medicine.medical_treatment
030209 endocrinology & metabolism
renin-angiotensin system
030204 cardiovascular system & hematology
respiration
artificial
Diseases of the endocrine glands. Clinical endocrinology
law.invention
Cohort Studies
03 medical and health sciences
0302 clinical medicine
law
Risk Factors
Diabetes mellitus
Internal medicine
Republic of Korea
Extracorporeal membrane oxygenation
medicine
angiotensin receptor antagonists
Humans
Renal replacement therapy
Antihypertensive Agents
Aged
Mechanical ventilation
business.industry
Odds ratio
Middle Aged
medicine.disease
RC648-665
Intensive care unit
Confidence interval
Hospitalization
angiotensin-converting enzyme inhibitors
Intensive Care Units
covid-19
Original Article
Female
business
Cohort study
Zdroj: Diabetes & Metabolism Journal, Vol 45, Iss 3, Pp 430-438 (2021)
Diabetes & Metabolism Journal
ISSN: 2233-6087
2233-6079
Popis: Background Angiotensin-converting enzyme 2 facilitates the entry of severe acute respiratory syndrome coronavirus 2 into the human body. We investigated the association of renin-angiotensin-aldosterone system (RAAS) inhibitor use with severe coronavirus disease 2019 (COVID-19) outcomes in hypertensive patients. Methods We identified hypertensive patients with confirmed COVID-19 from the Korean Health Insurance Review and Assessment Service from inception to May 15, 2020. The primary outcome was the composite of intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), continuous renal replacement therapy (CRRT), extracorporeal membrane oxygenation (ECMO), and death from COVID-19. The individual components were evaluated as secondary outcomes. Results Of 1,374 hypertensive patients with COVID-19, 1,076 (78.3%) and 298 (21.7%) were users and never-users of RAAS inhibitors, respectively. The RAAS inhibitor users were not associated with the risk of the primary outcome (adjusted odds ratio [aOR], 0.72; 95% confidence interval [CI], 0.46 to 1.10). The risk of ICU admission was significantly lower in the users than the never-users (aOR, 0.44; 95% CI, 0.24 to 0.84). The RAAS inhibitors were beneficial only in ICU admissions that did not require IMV (aOR, 0.28; 95% CI, 0.14 to 0.58). The risk of death from COVID-19 was comparable between the groups (aOR, 1.09; 95% CI, 0.64 to 1.85). We could not evaluate the risks of CRRT and ECMO owing to the small number of events. Conclusion RAAS inhibitor use was not associated with the composite of severe outcomes in the hypertensive patients with COVID-19 but significantly lowered the risk of ICU admission, particularly in patients who did not require IMV.
Databáze: OpenAIRE
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