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COVID-19: Original Article
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
Ju Hwan Kim, Yeon-Hee Baek, Hyesung Lee, Young June Choe, Hyun Joon Shin, Ju-Young Shin
Epidemiol Health. 2021;43:e2021004.   Published online December 29, 2020
DOI: https://doi.org/10.4178/epih.e2021004
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  • 8 Web of Science
  • 8 Crossref
AbstractAbstract AbstractSummary PDF
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.
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.

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
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    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
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    Cardiology Discovery.2021; 1(4): 233.     CrossRef

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