关键词: COVID-19 Candesartan Enalapril Hospitalization Mortality

Mesh : Humans COVID-19 / mortality epidemiology Angiotensin-Converting Enzyme Inhibitors / therapeutic use Male Female Hospitalization / statistics & numerical data Middle Aged Angiotensin Receptor Antagonists / therapeutic use Aged Case-Control Studies Antihypertensive Agents / therapeutic use Spain / epidemiology Hypertension / drug therapy Aged, 80 and over Disease Progression

来  源:   DOI:10.1007/s10787-024-01475-2   PDF(Pubmed)

Abstract:
OBJECTIVE: To assess the impact of prior chronic treatment with angiotensin-converting enzyme inhibitors (ACEIs)/ angiotensin-receptor blockers (ARBs), both as a group and by active ingredient, on severity (risk of hospitalization and mortality), progression of and susceptibility to COVID-19.
METHODS: We conducted a multiple population-based case-control study in Galicia (north-west Spain). The study data were sourced from medical, administrative and clinical databases. We assessed: (1) risk of hospitalization, by selecting all patients hospitalized due to COVID-19 with PCR + as cases, and a random sample of subjects without a PCR + as controls; (2) COVID-19 mortality risk; (3) risk of disease progression; and (4) susceptibility to SARS-CoV-2, considering all patients with PCR + as cases, and the same subjects used in the previous model as controls. Adjusted odds ratios (aORs) were calculated.
RESULTS: ACEIs and ARBs were shown to decrease the risk of hospitalization (aOR = 0.78 [95%CI 0.69-0.89] and aOR = 0.80 [95%CI 0.72-0.90] respectively), risk of mortality (aOR = 0.71 [95%CI 0.52-0.98] and aOR = 0.69 [95%CI 0.52-0.91] respectively), and susceptibility to the virus (aOR = 0.88 [95%CI 0.82-0.94] and aOR = 0.92 [95%CI 0.86-0.97] respectively). By active ingredient: use of enalapril was associated with a significantly lower risk of hospitalization (aOR = 0.72 [95%CI 0.61-0.85]), mortality (aOR = 0.59 [95%CI 0.38-0.92]) and susceptibility to COVID-19 (aOR = 0.86 [95%CI 0.79-0.94]); and use of candesartan was associated with a decreased risk of hospitalization (aOR = 0.76 [95%CI 0.60-0.95]), mortality (aOR = 0.36 [95%CI 0.17-0.75]) and disease progression (aOR = 0.73 [95%CI 0.56-0.95]).
CONCLUSIONS: This large-scale real-world data study suggest that enalapril and candesartan are associated with a considerable reduction in risk of severe COVID19 outcomes.
摘要:
目的:评估血管紧张素转换酶抑制剂(ACEI)/血管紧张素受体阻滞剂(ARB)长期治疗的影响,作为一个群体和活性成分,严重程度(住院风险和死亡率),COVID-19的进展和易感性。
方法:我们在加利西亚(西班牙西北部)进行了一项基于多人群的病例对照研究。研究数据来自医学,管理和临床数据库。我们评估:(1)住院风险,通过PCR+选择所有因COVID-19住院的患者作为病例,和一个没有PCR+的受试者的随机样本作为对照;(2)COVID-19死亡风险;(3)疾病进展风险;和(4)对SARS-CoV-2的易感性,考虑到所有PCR+的患者作为病例,和以前模型中使用的相同受试者作为对照。计算调整后的比值比(aOR)。
结果:ACEI和ARB显示降低住院风险(分别为aOR=0.78[95CI0.69-0.89]和aOR=0.80[95CI0.72-0.90]),死亡风险(分别为aOR=0.71[95CI0.52-0.98]和aOR=0.69[95CI0.52-0.91]),和对病毒的易感性(分别为aOR=0.88[95CI0.82-0.94]和aOR=0.92[95CI0.86-0.97])。通过活性成分:使用依那普利与住院风险显着降低相关(aOR=0.72[95CI0.61-0.85]),死亡率(aOR=0.59[95CI0.38-0.92])和对COVID-19的易感性(aOR=0.86[95CI0.79-0.94]);使用坎地沙坦与住院风险降低相关(aOR=0.76[95CI0.60-0.95]),死亡率(aOR=0.36[95CI0.17-0.75])和疾病进展(aOR=0.73[95CI0.56-0.95])。
结论:这项大规模的现实世界数据研究表明,依那普利和坎地沙坦与严重COVID19结局的风险大大降低有关。
公众号