TY - JOUR
T1 - Antecedent use of renin-angiotensin system inhibitors is associated with reduced mortality in elderly hypertensive Covid-19 patients
AU - Gori, M.
AU - Berzuini, C.
AU - D'Elia, E.
AU - Ghirardi, A.
AU - Bernardinelli, L.
AU - Gavazzi, A.
AU - Balestrieri, G.
AU - Giammarresi, A.
AU - Trevisan, R.
AU - Di Marco, F.
AU - Bellasi, A.
AU - Amoroso, M.
AU - Raimondi, F.
AU - Novelli, L.
AU - Magro, B.
AU - Mangia, G.
AU - Lorini, F.L.
AU - Guagliumi, G.
AU - Fagiuoli, S.
AU - Parati, G.
AU - Senni, M.
N1 - Funding Information:
Funding for this study was provided from Research Foundation of the Bergamo Hospital; Clinical and Pharmacological Research Project for a Covid-19 Treatment ‘3x1’.
Publisher Copyright:
© 2021 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2022/4/1
Y1 - 2022/4/1
N2 - Objectives:The effect of renin-angiotensin system inhibitors (RASIs) on mortality in patients with coronavirus disease (Covid-19) is debated. From a cohort of 1352 consecutive patients admitted with Covid-19 to Papa Giovanni XXIII Hospital in Bergamo, Italy, between February and April 2020, we selected and studied hypertensive patients to assess whether antecedent (prior to hospitalization) use of RASIs might affect mortality from Covid-19 according to age.Methods and results:Arterial hypertension was present in 688 patients. Overall mortality (in-hospital or shortly after discharge) was 35% (N = 240). After adjusting for 26 medical history variables via propensity score matching, antecedent use of RASIs (N = 459, 67%) was associated with a lower mortality in older hypertensive patients (age above the median of 68 years in the whole series), whereas no evidence of a significant effect was found in the younger group of the same population (P interaction = 0.001). In an analysis of the subgroup of 432 hypertensive patients older than 68 years, we considered two RASI drug subclasses, angiotensin-converting enzyme inhibitors (ACEIs, N = 156) and angiotensin receptor blockers (ARBs, N = 140), and assessed their respective effects by taking no-antecedent-use of RASIs as reference. This analysis showed that both antecedent use of ACEIs and antecedent use of ARBs were associated with a lower Covid-19 mortality (odds ratioACEI = 0.57, 95% confidence interval 0.36 - 0.91, P = 0.018) (odds ratioARB = 0.49, 95% confidence interval 0.29 - 0.82, P = 0.006).Conclusion:In the population of over-68 hypertensive Covid-19 patients, antecedent use of ACEIs or ARBs was associated with a lower all-cause mortality, whether in-hospital or shortly after discharge, compared with no-antecedent-use of RASIs.
AB - Objectives:The effect of renin-angiotensin system inhibitors (RASIs) on mortality in patients with coronavirus disease (Covid-19) is debated. From a cohort of 1352 consecutive patients admitted with Covid-19 to Papa Giovanni XXIII Hospital in Bergamo, Italy, between February and April 2020, we selected and studied hypertensive patients to assess whether antecedent (prior to hospitalization) use of RASIs might affect mortality from Covid-19 according to age.Methods and results:Arterial hypertension was present in 688 patients. Overall mortality (in-hospital or shortly after discharge) was 35% (N = 240). After adjusting for 26 medical history variables via propensity score matching, antecedent use of RASIs (N = 459, 67%) was associated with a lower mortality in older hypertensive patients (age above the median of 68 years in the whole series), whereas no evidence of a significant effect was found in the younger group of the same population (P interaction = 0.001). In an analysis of the subgroup of 432 hypertensive patients older than 68 years, we considered two RASI drug subclasses, angiotensin-converting enzyme inhibitors (ACEIs, N = 156) and angiotensin receptor blockers (ARBs, N = 140), and assessed their respective effects by taking no-antecedent-use of RASIs as reference. This analysis showed that both antecedent use of ACEIs and antecedent use of ARBs were associated with a lower Covid-19 mortality (odds ratioACEI = 0.57, 95% confidence interval 0.36 - 0.91, P = 0.018) (odds ratioARB = 0.49, 95% confidence interval 0.29 - 0.82, P = 0.006).Conclusion:In the population of over-68 hypertensive Covid-19 patients, antecedent use of ACEIs or ARBs was associated with a lower all-cause mortality, whether in-hospital or shortly after discharge, compared with no-antecedent-use of RASIs.
KW - Covid-19
KW - angiotensin receptor blockers
KW - angiotensin-converting enzyme inhibitors
KW - elderly
KW - hypertension
KW - observational study
KW - propensity score matching
KW - renin-angiotensin-system inhibitors
U2 - 10.1097/HJH.0000000000003059
DO - 10.1097/HJH.0000000000003059
M3 - Article
SN - 0263-6352
VL - 40
SP - 666
EP - 674
JO - Journal of hypertension
JF - Journal of hypertension
IS - 4
ER -