@article{Zhang_P-2020_11762,
title = {Association of inpatient use of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers with mortality among patients with hypertension hospitalized with COVID-19},
author = {Zhang, P. and Zhu, L. and Cai, J. and Lei, F. and Qin, J. and Xie, J. and Liu, Y. and Zhao, Y. and Huang, X. and Lin, L. and Xia, M. and Chen, M. and Cheng, X. and Zhang, X. and Guo, D. and Peng, Y. and Ji, Y. and Chen, J. and She, Z. and Wang, Y. and Xu, Q. and Tan, R. and Wang, H. and Lin, J. and Luo, P. and Fu, S. and Cai, H. and Ye, P. and Xiao, B. and Mao, W. and Liu, L. and Yan, Y. and Liu, M. and Chen, M. and Zhang, X. and Wang, X. and Touyz, R. and Xia, J. and Zhang, B. and Huang, X. and Yuan, Y. and Rohit, L. and Liu, P. and Li, H.},
month = {jun},
year = {2020},
abstract = {Rationale: Use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) 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 COVID-19 patients with hypertension. 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 [IQR 55-68] years; 53.2% men) and 940 without using ACEI/ARB (non-ACEI/ARB group; median age 64 [IQR 57-69]; 53.5% men), who were admitted to nine hospitals in Hubei Province, China from December 31, 2019 to February 20, 2020. Unadjusted mortality rate was lower in the ACEI/ARB group versus the non-ACEI/ARB group (3.7% vs. 9.8%; P = 0.01). 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 HR, 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 HR, 0.37; 95% CI, 0.15-0.89; P = 0.03). Further subgroup propensity score-matched analysis indicated that, compared to use of other antihypertensive drugs, ACEI/ARB was also associated with decreased mortality (adjusted HR, 0.30; 95%CI, 0.12-0.70; P = 0.01) in COVID-19 patients with hypertension. Conclusions: Among hospitalized COVID-19 patients with hypertension, inpatient use of ACEI/ARB was associated with lower risk of all-cause mortality compared with ACEI/ARB non-users. 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.},
pages = {1671-1681},
volume = {126},
issue = {12},
journal = {Circulation Research},
publisher = {American Heart Association},
url = {http://dx.doi.org/10.1161/circresaha.120.317134},
}
