Renin–Angiotensin System Blockers and Adverse Outcomes of Influenza and Pneumonia: A Danish Cohort Study
Background Angiotensin‐converting enzyme inhibitors (ACE‐Is) and angiotensin receptor blockers (ARBs) may worsen the prognosis of coronavirus disease 2019, but any association could be confounded by the cardiometabolic conditions indicating ACE‐I/ARB use. We therefore examined the impact of ACE‐Is/A...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2020-10-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.017297 |
| _version_ | 1811334029137412096 |
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| author | Christian Fynbo Christiansen Uffe Heide‐Jørgensen Thomas Bøjer Rasmussen Jacob Bodilsen Ole Schmeltz Søgaard Michael Maeng Simon Tilma Vistisen Morten Schmidt Anton Pottegård Lars Christian Lund Mette Reilev Jesper Hallas Nanna Borup Johansen Nikolai Constantin Brun Henrik Toft Sørensen Reimar Wernich Thomsen |
| author_facet | Christian Fynbo Christiansen Uffe Heide‐Jørgensen Thomas Bøjer Rasmussen Jacob Bodilsen Ole Schmeltz Søgaard Michael Maeng Simon Tilma Vistisen Morten Schmidt Anton Pottegård Lars Christian Lund Mette Reilev Jesper Hallas Nanna Borup Johansen Nikolai Constantin Brun Henrik Toft Sørensen Reimar Wernich Thomsen |
| author_sort | Christian Fynbo Christiansen |
| collection | DOAJ |
| description | Background Angiotensin‐converting enzyme inhibitors (ACE‐Is) and angiotensin receptor blockers (ARBs) may worsen the prognosis of coronavirus disease 2019, but any association could be confounded by the cardiometabolic conditions indicating ACE‐I/ARB use. We therefore examined the impact of ACE‐Is/ARBs on respiratory tract infection outcomes. Methods and Results This cohort study included all adult patients hospitalized with influenza or pneumonia from 2005 to 2018 in Denmark using population‐based medical databases. Thirty‐day mortality and risk of admission to the intensive care unit in ACE‐Is/ARBs users was compared with nonusers and with users of calcium channel blockers. We used propensity scores to handle confounding and computed propensity score‐weighted risks, risk differences (RDs), and risk ratios (RRs). Of 568 019 patients hospitalized with influenza or pneumonia, 100 278 were ACE‐I/ARB users and 37 961 were users of calcium channel blockers. In propensity score‐weighted analyses, ACE‐I/ARB users had marginally lower 30‐day mortality than users of calcium channel blockers (13.9% versus 14.5%; RD, −0.6%; 95% CI, −1.0 to −0.1; RR, 0.96; 95% CI, 0.93–0.99), and a lower risk of admission to the intensive care unit (8.0% versus 9.6%; RD, −1.6%; 95% CI, −2.0 to −1.2; RR, 0.83; 95% CI, 0.80–0.87). Compared with nonusers, current ACE‐I/ARB users had lower mortality (RD, −2.4%; 95% CI, −2.8 to −2.0; RR, 0.85; 95% CI, 0.83–0.87), but similar risk of admission to the intensive care unit (RD, 0.4%; 95% CI, 0.0–0.7; RR, 1.04; 95% CI, 1.00–1.09). Conclusions Among patients with influenza or pneumonia, ACE‐I/ARB users had no increased risk of admission to the intensive care unit and slightly reduced mortality after controlling for confounding. |
| first_indexed | 2024-04-13T17:01:42Z |
| format | Article |
| id | doaj.art-ba09a66a2e4d409a85c66c0547e82b8b |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T17:01:42Z |
| publishDate | 2020-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-ba09a66a2e4d409a85c66c0547e82b8b2022-12-22T02:38:38ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802020-10-0191910.1161/JAHA.120.017297Renin–Angiotensin System Blockers and Adverse Outcomes of Influenza and Pneumonia: A Danish Cohort StudyChristian Fynbo Christiansen0Uffe Heide‐Jørgensen1Thomas Bøjer Rasmussen2Jacob Bodilsen3Ole Schmeltz Søgaard4Michael Maeng5Simon Tilma Vistisen6Morten Schmidt7Anton Pottegård8Lars Christian Lund9Mette Reilev10Jesper Hallas11Nanna Borup Johansen12Nikolai Constantin Brun13Henrik Toft Sørensen14Reimar Wernich Thomsen15Department of Clinical Epidemiology Aarhus University Hospital Aarhus DenmarkDepartment of Clinical Epidemiology Aarhus University Hospital Aarhus DenmarkDepartment of Clinical Epidemiology Aarhus University Hospital Aarhus DenmarkDepartment of Infectious Diseases Aalborg University Hospital Aalborg DenmarkDepartment of Infectious Diseases Aarhus University Hospital Aarhus DenmarkDepartment of Cardiology Aarhus University Hospital Aarhus DenmarkDepartment of Intensive Care Aarhus University Hospital Aarhus DenmarkDepartment of Clinical Epidemiology Aarhus University Hospital Aarhus DenmarkClinical Pharmacology and Pharmacy Department of Public Health University of Southern Denmark Odense DenmarkClinical Pharmacology and Pharmacy Department of Public Health University of Southern Denmark Odense DenmarkClinical Pharmacology and Pharmacy Department of Public Health University of Southern Denmark Odense DenmarkClinical Pharmacology and Pharmacy Department of Public Health University of Southern Denmark Odense DenmarkDepartment of Medical Evaluation and Biostatistics Danish Medicines Agency Copenhagen DenmarkDepartment of Medical Evaluation and Biostatistics Danish Medicines Agency Copenhagen DenmarkDepartment of Clinical Epidemiology Aarhus University Hospital Aarhus DenmarkDepartment of Clinical Epidemiology Aarhus University Hospital Aarhus DenmarkBackground Angiotensin‐converting enzyme inhibitors (ACE‐Is) and angiotensin receptor blockers (ARBs) may worsen the prognosis of coronavirus disease 2019, but any association could be confounded by the cardiometabolic conditions indicating ACE‐I/ARB use. We therefore examined the impact of ACE‐Is/ARBs on respiratory tract infection outcomes. Methods and Results This cohort study included all adult patients hospitalized with influenza or pneumonia from 2005 to 2018 in Denmark using population‐based medical databases. Thirty‐day mortality and risk of admission to the intensive care unit in ACE‐Is/ARBs users was compared with nonusers and with users of calcium channel blockers. We used propensity scores to handle confounding and computed propensity score‐weighted risks, risk differences (RDs), and risk ratios (RRs). Of 568 019 patients hospitalized with influenza or pneumonia, 100 278 were ACE‐I/ARB users and 37 961 were users of calcium channel blockers. In propensity score‐weighted analyses, ACE‐I/ARB users had marginally lower 30‐day mortality than users of calcium channel blockers (13.9% versus 14.5%; RD, −0.6%; 95% CI, −1.0 to −0.1; RR, 0.96; 95% CI, 0.93–0.99), and a lower risk of admission to the intensive care unit (8.0% versus 9.6%; RD, −1.6%; 95% CI, −2.0 to −1.2; RR, 0.83; 95% CI, 0.80–0.87). Compared with nonusers, current ACE‐I/ARB users had lower mortality (RD, −2.4%; 95% CI, −2.8 to −2.0; RR, 0.85; 95% CI, 0.83–0.87), but similar risk of admission to the intensive care unit (RD, 0.4%; 95% CI, 0.0–0.7; RR, 1.04; 95% CI, 1.00–1.09). Conclusions Among patients with influenza or pneumonia, ACE‐I/ARB users had no increased risk of admission to the intensive care unit and slightly reduced mortality after controlling for confounding.https://www.ahajournals.org/doi/10.1161/JAHA.120.017297angiotensin receptor blockersangiotensin‐converting enzyme inhibitorcohort studyinfectious diseaseintensive care unit |
| spellingShingle | Christian Fynbo Christiansen Uffe Heide‐Jørgensen Thomas Bøjer Rasmussen Jacob Bodilsen Ole Schmeltz Søgaard Michael Maeng Simon Tilma Vistisen Morten Schmidt Anton Pottegård Lars Christian Lund Mette Reilev Jesper Hallas Nanna Borup Johansen Nikolai Constantin Brun Henrik Toft Sørensen Reimar Wernich Thomsen Renin–Angiotensin System Blockers and Adverse Outcomes of Influenza and Pneumonia: A Danish Cohort Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease angiotensin receptor blockers angiotensin‐converting enzyme inhibitor cohort study infectious disease intensive care unit |
| title | Renin–Angiotensin System Blockers and Adverse Outcomes of Influenza and Pneumonia: A Danish Cohort Study |
| title_full | Renin–Angiotensin System Blockers and Adverse Outcomes of Influenza and Pneumonia: A Danish Cohort Study |
| title_fullStr | Renin–Angiotensin System Blockers and Adverse Outcomes of Influenza and Pneumonia: A Danish Cohort Study |
| title_full_unstemmed | Renin–Angiotensin System Blockers and Adverse Outcomes of Influenza and Pneumonia: A Danish Cohort Study |
| title_short | Renin–Angiotensin System Blockers and Adverse Outcomes of Influenza and Pneumonia: A Danish Cohort Study |
| title_sort | renin angiotensin system blockers and adverse outcomes of influenza and pneumonia a danish cohort study |
| topic | angiotensin receptor blockers angiotensin‐converting enzyme inhibitor cohort study infectious disease intensive care unit |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.017297 |
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