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Clinical outcomes of COVID-19 following the use of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers among patients with hypertension in Korea: a nationwide study
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Ju Hwan Kim, Yeon-Hee Baek, Hyesung Lee, Young June Choe, Hyun Joon Shin, Ju-Young Shin
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Epidemiol Health. 2021;43:e2021004. Published online December 29, 2020
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DOI: https://doi.org/10.4178/epih.e2021004
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Abstract
OBJECTIVES Recent evidence has shown no harm associated with the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) in patients with coronavirus disease 2019 (COVID-19). We sought to further clarify the possible association between ACEI/ARB use and the risk of poor clinical outcomes of COVID-19.
METHODS From the completely enumerated COVID-19 cohort in Korea, we identified 1,290 patients with hypertension, of whom 682 had and 603 did not have records of ACEI/ARB use during the 30-day period before their COVID-19 diagnosis. Our primary endpoint comprised clinical outcomes, including all-cause mortality, use of mechanical ventilation, intensive care unit admission, and sepsis. We used inverse probability of treatment weighting (IPTW) to mitigate selection bias, and a Poisson regression model to estimate the relative risks (RRs) and 95% confidence intervals (CIs) for comparing outcomes between ACEI/ARB users and non-users.
RESULTS Compared to non-use, ACEI/ARB use was associated with lower clinical outcomes (IPTW-adjusted RR, 0.60; 95% CI, 0.42 to 0.85; p=0.005). For individual outcomes, ACEI/ARB use was not associated with all-cause mortality (IPTW-adjusted RR, 0.62; 95% CI, 0.35 to 1.09; p=0.097) or respiratory events (IPTW-adjusted RR, 0.99; 95% CI, 0.84 to 1.17; p=0.904). Subgroup analysis showed a trend toward a protective role of ACEIs and ARBs against overall outcomes in men (IPTW-adjusted RR, 0.84; 95% CI, 0.69 to 1.03; p<sub>interaction</sub>=0.008) and patients with pre-existing respiratory disease (IPTW-adjusted RR, 0.74; 95% CI, 0.60 to 0.92; p<sub>interaction</sub>=0.002).
CONCLUSIONS We present clinical evidence to support continuing ACE/ARB use in COVID-19 patients with hypertension based on the completely enumerated Korean cohort.
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Summary
Korean summary
– 코로나-19 검사를 받은 69,793명 중에 코로나-19 양성이며 고혈압이 있는 1,290명을 연구대상자로 선정했으며, 이중 코로나-19 진단일로부터 30일이내에 ACEI 또는 ARB를 사용한 환자는 682명이었음.
– ACEI 또는 ARB 사용은 비사용 대비 사망 또는 폐 관련 질환의 위험과의 관련성이 없었음.
– 하위그룹 분석에서 남성 또는 기저 폐질환 보유 환자에서 ACEI 또는 ARB 사용이 코로나-19 예후 악화를 예방하는 트렌드를 보였음.
Key Message
– Among 69,793 individuals screened for COVID-19, we identified 1,290 patients with hypertension who tested positive, of whom 682 had records of using ACEIs or ARBs in the 30 days before their COVID-19 diagnosis.
– ACEI/ARB use (compared with non-use) was not associated with all-cause mortality or respiratory events.
– A subgroup analysis showed a trend toward a protective role of ACEIs and ARBs against the overall composite endpoint of poor outcomes in men and those with pre-existing respiratory disease.
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Citations
Citations to this article as recorded by 
- Systematic review and meta-analysis of the clinical outcomes of ACEI/ARB in East-Asian patients with COVID-19
Nancy Xurui Huang, Qi Yuan, Fang Fang, Bryan P. Yan, John E. Sanderson, Masaki Mogi PLOS ONE.2023; 18(1): e0280280. CrossRef - Mortality and Severity in COVID-19 Patients on ACEIs and ARBs—A Systematic Review, Meta-Analysis, and Meta-Regression Analysis
Romil Singh, Sawai Singh Rathore, Hira Khan, Abhishek Bhurwal, Mack Sheraton, Prithwish Ghosh, Sohini Anand, Janaki Makadia, Fnu Ayesha, Kiran S. Mahapure, Ishita Mehra, Aysun Tekin, Rahul Kashyap, Vikas Bansal Frontiers in Medicine.2022;[Epub] CrossRef - Renin‐Angiotensin Aldosterone System Inhibitors and COVID‐19: A Systematic Review and Meta‐Analysis Revealing Critical Bias Across a Body of Observational Research
Jordan Loader, Frances C. Taylor, Erik Lampa, Johan Sundström Journal of the American Heart Association.2022;[Epub] CrossRef - Drugs acting on the renin–angiotensin–aldosterone system (RAAS) and deaths of COVID-19 patients: a systematic review and meta-analysis of observational studies
Ruchika Sharma, Anoop Kumar, Jaseela Majeed, Ajit K. Thakur, Geeta Aggarwal The Egyptian Heart Journal.2022;[Epub] CrossRef - Acute motor-sensory axonal polyneuropathy variant of Guillain–Barre syndrome complicating the recovery phase of coronavirus disease 2019 infection: a case report
Ahmed Maseh Haidary, Sarah Noor, Esmatullah Hamed, Tawab Baryali, Soma Rahmani, Maryam Ahmad, Farahnaz Erfani, Hashmatullah Azimi, Habib Ul Rahman Habib, Gul Ahmad Tahiri, Ramin Saadaat, Abdul Sami Ibrahimkhil, Esmatullah Esmat, Haider Ali Malakzai Journal of Medical Case Reports.2021;[Epub] CrossRef - Renin‐Angiotensin Aldosterone System Inhibitors in Primary Prevention and COVID‐19
Jordan Loader, Erik Lampa, Stefan Gustafsson, Thomas Cars, Johan Sundström Journal of the American Heart Association.2021;[Epub] CrossRef - Role of Hypertension on the Severity of COVID-19: A Review
Mei Peng, Jia He, Ying Xue, Xue Yang, Shao Liu, Zhicheng Gong Journal of Cardiovascular Pharmacology.2021; 78(5): e648. CrossRef - COVID-19, the Pandemic of the Century and Its Impact on Cardiovascular Diseases
Yuanyuan Zhang, Mingjie Wang, Xian Zhang, Tianxiao Liu, Peter Libby, Guo-Ping Shi Cardiology Discovery.2021; 1(4): 233. CrossRef
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Socioeconomic disparities in Korea by health insurance type during the COVID-19 pandemic: a nationwide study
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Han Eol Jeong, Jongseong Lee, Hyun Joon Shin, Ju-Young Shin
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Epidemiol Health. 2021;43:e2021007. Published online January 13, 2021
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DOI: https://doi.org/10.4178/epih.e2021007
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17,016
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Abstract
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Abstract
OBJECTIVES This study explored socioeconomic disparities in Korea using health insurance type as a proxy during the ongoing coronavirus disease 2019 (COVID-19) pandemic.
METHODS We conducted a retrospective cohort study using Korea’s nationwide healthcare database, which contained all individuals who received a diagnostic test for COVID-19 (n=232,390) as of May 15, 2020. We classified our cohort by health insurance type into beneficiaries of the National Health Insurance (NHI) or Medicaid programs. Our study outcomes were infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19-related outcomes, a composite of all-cause death, intensive care unit admission, and mechanical ventilation use. We estimated age-, sex-, and Charlson comorbidity index score–adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using a multivariable logistic regression analysis.
RESULTS Of the 218,070 NHI and 14,320 Medicaid beneficiaries who received COVID-19 tests, 7,777 and 738 tested positive, respectively. The Medicaid beneficiaries were older (mean age, 57.5 vs. 47.8 years), more likely to be males (47.2 vs. 40.2%), and had a higher comorbidity burden (mean CCI, 2.0 vs. 1.7) than NHI beneficiaries. Compared to NHI beneficiaries, Medicaid beneficiaries had a 22% increased risk of SARS-CoV-2 infection (aOR, 1.22; 95% CI, 1.09 to 1.38), but had no significantly elevated risk of COVID-19-related outcomes (aOR 1.10, 95% CI 0.77 to 1.57); the individual events of the composite outcome yielded similar findings.
CONCLUSIONS As socioeconomic factors, with health insurance as a proxy, could serve as determinants during the current pandemic, pre-emptive support is needed for high-risk groups to slow its spread.
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Summary
Korean summary
사회경제적 수준과 코로나19 발생률 및 예후 간 연관성 등 코로나19로 인한 건강 불평등 현상은 아직 확인된 바가 없다.
건강보험 가입자 대비 의료급여 수급권자에서 SARS-CoV-2의 감염 위험이 더 높게 나타났다.
코로나19의 확산을 늦추기 위해서는, 의료급여 수급권자를 비롯한 취약계층 대상의 선제적 지원이 제공되어야 한다.
Key Message
Socioeconomic status, with health insurance as a proxy, could explain health inequalities in clinical outcomes, diverse disease incidence and prognosis, during the COVID-19 pandemic.
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Citations
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