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Renin Angiotensin System Blockers and Risk of Mortality in Hypertensive Patients Hospitalized for COVID-19: An Italian Registry.
Angeli, Fabio; Verdecchia, Paolo; Balestrino, Antonella; Bruschi, Claudio; Ceriana, Piero; Chiovato, Luca; Dalla Vecchia, Laura Adelaide; Fanfulla, Francesco; La Rovere, Maria Teresa; Perego, Francesca; Scalvini, Simonetta; Spanevello, Antonio; Traversi, Egidio; Visca, Dina; Vitacca, Michele; Bachetti, Tiziana.
  • Angeli F; Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy.
  • Verdecchia P; Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 21049 Tradate, Italy.
  • Balestrino A; Fondazione Umbra Cuore e Ipertensione-ONLUS and Division of Cardiology, Hospital S. Maria Della Misericordia, 06100 Perugia, Italy.
  • Bruschi C; Department of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy.
  • Ceriana P; Department of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 27040 Montescano, Italy.
  • Chiovato L; Department of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy.
  • Dalla Vecchia LA; Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy.
  • Fanfulla F; Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy.
  • La Rovere MT; Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 20019 Milano, Italy.
  • Perego F; Department of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy.
  • Scalvini S; Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 27040 Montescano, Italy.
  • Spanevello A; Department of Subacute Therapy, Istituti Clinici Scientifici Maugeri IRCCS, 20019 Milano, Italy.
  • Traversi E; Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, Italy.
  • Visca D; Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy.
  • Vitacca M; Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 21049 Tradate, Italy.
  • Bachetti T; Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 27040 Montescano, Italy.
J Cardiovasc Dev Dis ; 9(1)2022 Jan 06.
Article in English | MEDLINE | ID: covidwho-1613840
ABSTRACT

BACKGROUND:

It is uncertain whether exposure to renin-angiotensin system (RAS) modifiers affects the severity of the new coronavirus disease 2019 (COVID-19) because most of the available studies are retrospective.

METHODS:

We tested the prognostic value of exposure to RAS modifiers (either angiotensin-converting enzyme inhibitors [ACE-Is] or angiotensin receptor blockers [ARBs]) in a prospective study of hypertensive patients with COVID-19. We analyzed data from 566 patients (mean age 75 years, 54% males, 162 ACE-Is users, and 147 ARBs users) hospitalized in five Italian hospitals. The study used systematic prospective data collection according to a pre-specified protocol. All-cause mortality during hospitalization was the primary outcome.

RESULTS:

Sixty-six patients died during hospitalization. Exposure to RAS modifiers was associated with a significant reduction in the risk of in-hospital mortality when compared to other BP-lowering strategies (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.32 to 0.90, p = 0.019). Exposure to ACE-Is was not significantly associated with a reduced risk of in-hospital mortality when compared with patients not treated with RAS modifiers (OR 0.66, 95% CI 0.36 to 1.20, p = 0.172). Conversely, ARBs users showed a 59% lower risk of death (OR 0.41, 95% CI 0.20 to 0.84, p = 0.016) even after allowance for several prognostic markers, including age, oxygen saturation, occurrence of severe hypotension during hospitalization, and lymphocyte count (adjusted OR 0.37, 95% CI 0.17 to 0.80, p = 0.012). The discontinuation of RAS modifiers during hospitalization did not exert a significant effect (p = 0.515).

CONCLUSIONS:

This prospective study indicates that exposure to ARBs reduces mortality in hospitalized patients with COVID-19.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Etiology study / Observational study / Risk factors Language: English Year: 2022 Document Type: Article Affiliation country: Jcdd9010015

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Etiology study / Observational study / Risk factors Language: English Year: 2022 Document Type: Article Affiliation country: Jcdd9010015