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
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 ri...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Korean Society of Epidemiology
2020-12-01
|
| Series: | Epidemiology and Health |
| Subjects: | |
| Online Access: | http://www.e-epih.org/upload/pdf/epih-43-e2021004.pdf |
| _version_ | 1828879749534973952 |
|---|---|
| author | Ju Hwan Kim Yeon-Hee Baek Hyesung Lee Young June Choe Hyun Joon Shin Ju-Young Shin |
| author_facet | Ju Hwan Kim Yeon-Hee Baek Hyesung Lee Young June Choe Hyun Joon Shin Ju-Young Shin |
| author_sort | Ju Hwan Kim |
| collection | DOAJ |
| description | 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; pinteraction=0.008) and patients with pre-existing respiratory disease (IPTW-adjusted RR, 0.74; 95% CI, 0.60 to 0.92; pinteraction=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. |
| first_indexed | 2024-12-13T09:34:31Z |
| format | Article |
| id | doaj.art-0c4e5828bf374cd1a3c940ebaff0a341 |
| institution | Directory Open Access Journal |
| issn | 2092-7193 |
| language | English |
| last_indexed | 2024-12-13T09:34:31Z |
| publishDate | 2020-12-01 |
| publisher | Korean Society of Epidemiology |
| record_format | Article |
| series | Epidemiology and Health |
| spelling | doaj.art-0c4e5828bf374cd1a3c940ebaff0a3412022-12-21T23:52:24ZengKorean Society of EpidemiologyEpidemiology and Health2092-71932020-12-014310.4178/epih.e20210041146Clinical outcomes of COVID-19 following the use of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers among patients with hypertension in Korea: a nationwide studyJu Hwan Kim0Yeon-Hee Baek1Hyesung Lee2Young June Choe3Hyun Joon Shin4Ju-Young Shin5 School of Pharmacy, Sungkyunkwan University, Suwon, Korea School of Pharmacy, Sungkyunkwan University, Suwon, Korea School of Pharmacy, Sungkyunkwan University, Suwon, Korea Division of Infectious Diseases, Department of Social and Preventive Medicine, Hallym University College of Medicine, Chuncheon, Korea Lemuel Shattuck Hospital, Boston, MA, USA School of Pharmacy, Sungkyunkwan University, Suwon, KoreaOBJECTIVES 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; pinteraction=0.008) and patients with pre-existing respiratory disease (IPTW-adjusted RR, 0.74; 95% CI, 0.60 to 0.92; pinteraction=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.http://www.e-epih.org/upload/pdf/epih-43-e2021004.pdfcovid-19hypertensionangiotensin-converting enzyme inhibitorsangiotensin-receptor blockers |
| spellingShingle | Ju Hwan Kim Yeon-Hee Baek Hyesung Lee Young June Choe Hyun Joon Shin Ju-Young Shin 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 Epidemiology and Health covid-19 hypertension angiotensin-converting enzyme inhibitors angiotensin-receptor blockers |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | covid-19 hypertension angiotensin-converting enzyme inhibitors angiotensin-receptor blockers |
| url | http://www.e-epih.org/upload/pdf/epih-43-e2021004.pdf |
| work_keys_str_mv | AT juhwankim clinicaloutcomesofcovid19followingtheuseofangiotensinconvertingenzymeinhibitorsorangiotensinreceptorblockersamongpatientswithhypertensioninkoreaanationwidestudy AT yeonheebaek clinicaloutcomesofcovid19followingtheuseofangiotensinconvertingenzymeinhibitorsorangiotensinreceptorblockersamongpatientswithhypertensioninkoreaanationwidestudy AT hyesunglee clinicaloutcomesofcovid19followingtheuseofangiotensinconvertingenzymeinhibitorsorangiotensinreceptorblockersamongpatientswithhypertensioninkoreaanationwidestudy AT youngjunechoe clinicaloutcomesofcovid19followingtheuseofangiotensinconvertingenzymeinhibitorsorangiotensinreceptorblockersamongpatientswithhypertensioninkoreaanationwidestudy AT hyunjoonshin clinicaloutcomesofcovid19followingtheuseofangiotensinconvertingenzymeinhibitorsorangiotensinreceptorblockersamongpatientswithhypertensioninkoreaanationwidestudy AT juyoungshin clinicaloutcomesofcovid19followingtheuseofangiotensinconvertingenzymeinhibitorsorangiotensinreceptorblockersamongpatientswithhypertensioninkoreaanationwidestudy |