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Different therapeutic associations of renin-angiotensin system inhibitors with coronavirus disease 2019 compared with usual pneumonia

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Background/Aims: Although it is near concluded that renin-angiotensin system inhibitors do not have a harmful effect on coronavirus disease 2019 (COVID-19), there is no report about whether angiotensin receptor blockers (ARBs) and angiotensin- converting enzyme inhibitors (ACEIs) offer any protective role. This study aimed to compare the association of ARBs and ACEIs with COVID-19-related mortality. Methods: All patients with COVID-19 in Korea between January 19 and April 16, 2020 were enrolled. The association of ARBs and ACEIs with mortality within 60 days were evaluated. A comparison of hazard ratio (HR) was performed between COVID-19 patients and a retrospective cohort of pneumonia patients hospitalized in 2019 in Korea. Results: Among 10,448 COVID-19 patients, ARBs and ACEIs were prescribed in 1,231 (11.7%) and 57 (0.6%) patients, respectively. After adjusting for age, sex, and history of comorbidities, the ARB group showed neutral association (HR, 1.034; 95% CI, 0.765 to 1.399; p = 0.8270) and the ACEI groups showed no significant associations likely owing to the small population size (HR, 0.736; 95% CI, 0.314 to 1.726; p = 0.4810). When comparing HR between COVID-19 patients and a retrospective cohort of patients hospitalized with pneumonia in 2019, the trend of ACEIs showed similar benefits, whereas the protective effect of ARBs observed in the retrospective cohort was absent in COVID-19 patients. Meta-analyses showed significant positive correlation with survival of ACEIs, whereas a neutral association between ARBs and mortality. Conclusions: Although ARBs or ACEIs were not associated with fatal outcomes, potential beneficial effects of ARBs observed in pneumonia were attenuated in COVID-19.

Abstract

Background/Aims: Although it is near concluded that renin-angiotensin system inhibitors do not have a harmful effect on coronavirus disease 2019 (COVID-19), there is no report about whether angiotensin receptor blockers (ARBs) and angiotensin- converting enzyme inhibitors (ACEIs) offer any protective role. This study aimed to compare the association of ARBs and ACEIs with COVID-19-related mortality. Methods: All patients with COVID-19 in Korea between January 19 and April 16, 2020 were enrolled. The association of ARBs and ACEIs with mortality within 60 days were evaluated. A comparison of hazard ratio (HR) was performed between COVID-19 patients and a retrospective cohort of pneumonia patients hospitalized in 2019 in Korea. Results: Among 10,448 COVID-19 patients, ARBs and ACEIs were prescribed in 1,231 (11.7%) and 57 (0.6%) patients, respectively. After adjusting for age, sex, and history of comorbidities, the ARB group showed neutral association (HR, 1.034; 95% CI, 0.765 to 1.399; p = 0.8270) and the ACEI groups showed no significant associations likely owing to the small population size (HR, 0.736; 95% CI, 0.314 to 1.726; p = 0.4810). When comparing HR between COVID-19 patients and a retrospective cohort of patients hospitalized with pneumonia in 2019, the trend of ACEIs showed similar benefits, whereas the protective effect of ARBs observed in the retrospective cohort was absent in COVID-19 patients. Meta-analyses showed significant positive correlation with survival of ACEIs, whereas a neutral association between ARBs and mortality. Conclusions: Although ARBs or ACEIs were not associated with fatal outcomes, potential beneficial effects of ARBs observed in pneumonia were attenuated in COVID-19.

참고문헌 (57)

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관련 논문AI추천

Clinical Outcomes From COVID-19 Following Use of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers Among Patients with Hypertension in South Korea: A nationwide study김주환, 신주영, 신현준, Baek Yeon-Hee, Choe Young June, Lee Hyesung한국역학회 · Epidemiology and Health2021 · 제43권 Effects of renin-angiotensin system blockers on the risk and outcomes of severe acute respiratory syndrome coronavirus 2 infection in patients with hypertensionDong-Ju Choi, Il-Young Oh, Ji Hyun Lee, Jin Joo Park, Jinwoo Lee, Seong Jin Jo, Youngjin Cho, Young-Seok Cho대한내과학회 · The Korean Journal of Internal Medicine2021 · 제36권 제1호Update on association between exposure to renin- angiotensin-aldosterone system inhibitors and coronavirus disease 2019 in South KoreaJeongkuk Seo, Minkook Son대한내과학회 · The Korean Journal of Internal Medicine2021 · 제36권 제1호Hypertension, renin-angiotensin-aldosterone-system-blocking agents, and COVID-19김철호, 연태진, 이동훈, 채인호, Dai Andrew M., Han Kyung-do, Jung Jin-Hyung, Kang Si-Hyuck, Park Sang-Hyun, Wei Henry G., Yoon Chang-Hwan대한고혈압학회 · Clinical Hypertension2021 · 제27권 제3호Effect of angiotensin converting enzyme inhibitor and angiotensin II receptor blocker on the patients with sepsisEun Jin Jang, Hyun Woo Lee, Jae Kyung Suh, Sang-Min Lee대한내과학회 · The Korean Journal of Internal Medicine2021 · 제36권 제2호Incidence and Mortality Associated with Cardiovascular Medication among Hypertensive COVID-19 Patients in South Korea서정원, 송인애, 오탁규, 조형원연세대학교의과대학 · Yonsei Medical Journal2021 · 제62권 제7호

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