Background:

Speculations whether treatment with angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin II receptor blockers (ARB) predisposes to severe coronavirus disease 2019 (COVID-19) or worsens its outcomes. This study assessed the association of ACE-I/ARB therapy with the development of severe COVID-19.

Methods:

This multi-center, prospective study enrolled patients hospitalized for COVID-19 and receiving one or more antihypertensive agents to manage either hypertension or cardiovascular disease. ACE-I/ARB therapy associations with severe COVID-19 on the day of hospitalization, intensive care unit (ICU) admission, mechanical ventilation and in-hospital death on follow-up were tested using a multivariate logistic regression model adjusted for age, obesity, and chronic illnesses. The composite outcome of mechanical ventilation and death was examined using the adjusted Cox multivariate regression model.

Results:

Of 338 enrolled patients, 245 (72.4%) were using ACE-I/ARB on the day of hospital admission, and 197 continued ACE-I/ARB therapy during hospitalization. Ninety-eight (29%) patients had a severe COVID-19, which was not significantly associated with the use of ACE-I/ARB (OR 1.17, 95% CI 0.66-2.09; P = .57). Prehospitalization ACE-I/ARB therapy was not associated with ICU admission, mechanical ventilation, or in-hospital death. Continuing ACE-I/ARB therapy during hospitalization was associated with decreased mortality (OR 0.22, 95% CI 0.073-0.67; P = .008). ACE-I/ARB use was not associated with developing the composite outcome of mechanical ventilation and in-hospital death (HR 0.95, 95% CI 0.51-1.78; P = .87) versus not using ACE-I/ARB.

Conclusion:

Patients with hypertension or cardiovascular diseases receiving ACE-I/ARB therapy are not at increased risk for severe COVID-19 on admission to the hospital. ICU admission, mechanical ventilation, and mortality are not associated with ACE-I/ARB therapy. Maintaining ACE-I/ARB therapy during hospitalization for COVID-19 lowers the likelihood of death.

Clinical Trial Registration:

ClinicalTrials.gov, NCT4357535.

中文翻译：

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血管紧张素转换酶抑制剂和血管紧张素 II 阻滞剂与 COVID-19 严重程度的关联：一项多中心、前瞻性研究

背景：

推测使用血管紧张素转换酶抑制剂 (ACE-I) 或血管紧张素 II 受体阻滞剂 (ARB) 治疗是否会导致严重的 2019 年冠状病毒病 (COVID-19) 或恶化其结果。本研究评估了 ACE-I/ARB 治疗与重症 COVID-19 发展的关系。

方法：

这项多中心、前瞻性研究招募了因 COVID-19 住院并接受一种或多种抗高血压药物治疗高血压或心血管疾病的患者。ACE-I/ARB 治疗与住院当天重症 COVID-19、重症监护病房 (ICU) 入院、机械通气和随访时住院死亡的关联使用针对年龄、肥胖进行调整的多变量逻辑回归模型进行了测试和慢性病。使用调整后的 Cox 多元回归模型检查机械通气和死亡的复合结果。

结果：

在入组的 338 名患者中，245 名（72.4%）在入院当天正在使用 ACE-I/ARB，197 名在住院期间继续使用 ACE-I/ARB 治疗。98 名 (29%) 患者患有严重的 COVID-19，这与使用 ACE-I/ARB 没有显着相关性（OR 1.17，95% CI 0.66-2.09；P = .57）。住院前 ACE-I/ARB 治疗与入住 ICU、机械通气或院内死亡无关。住院期间继续 ACE-I/ARB 治疗与死亡率降低相关（OR 0.22，95% CI 0.073-0.67；P = .008）。与不使用 ACE-I/ARB 相比，使用 ACE-I/ARB与发展机械通气和院内死亡的复合结局无关（HR 0.95，95% CI 0.51-1.78；P = .87）。

结论：

接受 ACE-I/ARB 治疗的高血压或心血管疾病患者在入院时患严重 COVID-19 的风险并未增加。ICU入院、机械通气和死亡率与ACE-I/ARB治疗无关。在 COVID-19 住院期间维持 ACE-I/ARB 治疗可降低死亡的可能性。

临床试验注册：

ClinicalTrials.gov，NCT4357535。