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Angiotensin II receptor blocker or angiotensin-converting enzyme inhibitor use and COVID-19-related outcomes among US Veterans.
Derington, Catherine G; Cohen, Jordana B; Mohanty, April F; Greene, Tom H; Cook, James; Ying, Jian; Wei, Guo; Herrick, Jennifer S; Stevens, Vanessa W; Jones, Barbara E; Wang, Libo; Zheutlin, Alexander R; South, Andrew M; Hanff, Thomas C; Smith, Steven M; Cooper-DeHoff, Rhonda M; King, Jordan B; Alexander, G Caleb; Berlowitz, Dan R; Ahmad, Faraz S; Penrod, M Jason; Hess, Rachel; Conroy, Molly B; Fang, James C; Rubin, Michael A; Beddhu, Srinivasan; Cheung, Alfred K; Xian, Weiming; Weintraub, William S; Bress, Adam P.
  • Derington CG; Department of Population Health Sciences, Division of Health System Innovation and Research, University of Utah School of Medicine, Salt Lake City, UT, United States of America.
  • Cohen JB; Department of Medicine, Renal-Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America.
  • Mohanty AF; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America.
  • Greene TH; George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, United States of America.
  • Cook J; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America.
  • Ying J; Department of Population Health Sciences, Division of Health System Innovation and Research, University of Utah School of Medicine, Salt Lake City, UT, United States of America.
  • Wei G; George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, United States of America.
  • Herrick JS; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America.
  • Stevens VW; Department of Population Health Sciences, Division of Health System Innovation and Research, University of Utah School of Medicine, Salt Lake City, UT, United States of America.
  • Jones BE; George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, United States of America.
  • Wang L; George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, United States of America.
  • Zheutlin AR; Department of Population Health Sciences, Division of Health System Innovation and Research, University of Utah School of Medicine, Salt Lake City, UT, United States of America.
  • South AM; George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, United States of America.
  • Hanff TC; Department of Population Health Sciences, Division of Health System Innovation and Research, University of Utah School of Medicine, Salt Lake City, UT, United States of America.
  • Smith SM; George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, United States of America.
  • Cooper-DeHoff RM; George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, United States of America.
  • King JB; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America.
  • Alexander GC; Department of Medicine, Division of Cardiology, University of Utah School of Medicine, Salt Lake City, UT, United States of America.
  • Berlowitz DR; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America.
  • Ahmad FS; Department of Pediatrics, Section of Nephrology, Brenner Children's Hospital, Wake Forest School of Medicine, Winston Salem, NC, United States of America.
  • Penrod MJ; Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC, United States of America.
  • Hess R; Department of Medicine, Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America.
  • Conroy MB; Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, United States of America.
  • Fang JC; Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, United States of America.
  • Rubin MA; Department of Medicine, University of Florida, College of Medicine, Gainesville, FL, United States of America.
  • Beddhu S; Department of Population Health Sciences, Division of Health System Innovation and Research, University of Utah School of Medicine, Salt Lake City, UT, United States of America.
  • Cheung AK; Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, United States of America.
  • Xian W; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
  • Weintraub WS; Department of Public Health; University of Massachusetts Lowell, Lowell, MA, United States of America.
  • Bress AP; Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States of America.
PLoS One ; 16(4): e0248080, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1199975
ABSTRACT

BACKGROUND:

Angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) may positively or negatively impact outcomes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We investigated the association of ARB or ACEI use with coronavirus disease 2019 (COVID-19)-related outcomes in US Veterans with treated hypertension using an active comparator design, appropriate covariate adjustment, and negative control analyses. METHODS AND

FINDINGS:

In this retrospective cohort study of Veterans with treated hypertension in the Veterans Health Administration (01/19/2020-08/28/2020), we compared users of (A) ARB/ACEI vs. non-ARB/ACEI (excluding Veterans with compelling indications to reduce confounding by indication) and (B) ARB vs. ACEI among (1) SARS-CoV-2+ outpatients and (2) COVID-19 hospitalized inpatients. The primary outcome was all-cause hospitalization or mortality (outpatients) and all-cause mortality (inpatients). We estimated hazard ratios (HR) using propensity score-weighted Cox regression. Baseline characteristics were well-balanced between exposure groups after weighting. Among outpatients, there were 5.0 and 6.0 primary outcomes per 100 person-months for ARB/ACEI (n = 2,482) vs. non-ARB/ACEI (n = 2,487) users (HR 0.85, 95% confidence interval [CI] 0.73-0.99, median follow-up 87 days). Among outpatients who were ARB (n = 4,877) vs. ACEI (n = 8,704) users, there were 13.2 and 14.8 primary outcomes per 100 person-months (HR 0.91, 95%CI 0.86-0.97, median follow-up 85 days). Among inpatients who were ARB/ACEI (n = 210) vs. non-ARB/ACEI (n = 275) users, there were 3.4 and 2.0 all-cause deaths per 100 person months (HR 1.25, 95%CI 0.30-5.13, median follow-up 30 days). Among inpatients, ARB (n = 1,164) and ACEI (n = 2,014) users had 21.0 vs. 17.7 all-cause deaths, per 100 person-months (HR 1.13, 95%CI 0.93-1.38, median follow-up 30 days).

CONCLUSIONS:

This observational analysis supports continued ARB or ACEI use for patients already using these medications before SARS-CoV-2 infection. The novel beneficial association observed among outpatients between users of ARBs vs. ACEIs on hospitalization or mortality should be confirmed with randomized trials.
Asunto(s)

Texto completo: Disponible Colección: Bases de datos internacionales Base de datos: MEDLINE Asunto principal: Inhibidores de la Enzima Convertidora de Angiotensina / Antagonistas de Receptores de Angiotensina / COVID-19 / Hipertensión Tipo de estudio: Estudio de cohorte / Estudio experimental / Estudio observacional / Estudio pronóstico / Ensayo controlado aleatorizado Tópicos: Variantes Límite: Anciano / Femenino / Humanos / Masculino / Middle aged Idioma: Inglés Revista: PLoS One Asunto de la revista: Ciencia / Medicina Año: 2021 Tipo del documento: Artículo País de afiliación: Journal.pone.0248080

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Texto completo: Disponible Colección: Bases de datos internacionales Base de datos: MEDLINE Asunto principal: Inhibidores de la Enzima Convertidora de Angiotensina / Antagonistas de Receptores de Angiotensina / COVID-19 / Hipertensión Tipo de estudio: Estudio de cohorte / Estudio experimental / Estudio observacional / Estudio pronóstico / Ensayo controlado aleatorizado Tópicos: Variantes Límite: Anciano / Femenino / Humanos / Masculino / Middle aged Idioma: Inglés Revista: PLoS One Asunto de la revista: Ciencia / Medicina Año: 2021 Tipo del documento: Artículo País de afiliación: Journal.pone.0248080