Hypertension, medications, and risk of severe COVID-19: A Massachusetts community-based observational study

被引:29
作者
Bauer, Ann Z. [1 ]
Gore, Rebecca [1 ]
Sama, Susan R. [1 ,2 ]
Rosiello, Richard [2 ]
Garber, Lawrence [2 ]
Sundaresan, Devi [2 ]
McDonald, Anne [2 ]
Arruda, Patricia [2 ]
Kriebel, David [1 ]
机构
[1] Univ Massachusetts, Dept Publ Hlth, 1 Univ Ave, Lowell, MA 01854 USA
[2] Reliant Med Grp Inc, Worcester, MA USA
关键词
angiotensin receptor blockers; angiotensin-converting enzyme inhibitors; COVID-19; hypertension; renin-angiotensin system; RENIN-ANGIOTENSIN SYSTEM; ACE2;
D O I
10.1111/jch.14101
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
It remains uncertain whether the hypertension (HT) medications angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) mitigate or exacerbate SARS-CoV-2 infection. We evaluated the association of ACEi and ARB with severe coronavirus disease 19 (COVID-19) as defined by hospitalization or mortality among individuals diagnosed with COVID-19. We investigated whether these associations were modified by age, the simultaneous use of the diuretic thiazide, and the health conditions associated with medication use. In an observational study utilizing data from a Massachusetts group medical practice, we identified 1449 patients with a COVID-19 diagnosis. In our study, pre-infection comorbidities including HT, cardiovascular disease, and diabetes were associated with increased risk of severe COVID-19. Risk was further elevated in patients under age 65 with these comorbidities or cancer. Twenty percent of those with severe COVID-19 compared to 9% with less severe COVID-19 used ACEi, 8% and 4%, respectively, used ARB. In propensity score-matched analyses, use of neither ACEi (OR = 1.30, 95% CI 0.93 to 1.81) nor ARB (OR = 0.94, 95% CI 0.57 to 1.55) was associated with increased risk of severe COVID-19. Thiazide use did not modify this relationship. Beta blockers, calcium channel blockers, and anticoagulant medications were not associated with COVID-19 severity. In conclusion, cardiovascular-related comorbidities were associated with severe COVID-19 outcomes, especially among patients under age 65. We found no substantial increased risk of severe COVID-19 among patients taking antihypertensive medications. Our findings support recommendations against discontinuing use of renin-angiotensin system (RAS) inhibitors to prevent severe COVID-19.
引用
收藏
页码:21 / 27
页数:7
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