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Continued In-Hospital Angiotensin-Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Use in Hypertensive COVID-19 Patients Is Associated With Positive Clinical Outcome.
J Infect Dis. 2020 09 14; 222(8):1256-1264.JI

Abstract

BACKGROUND

This study investigated continued and discontinued use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB) during hospitalization of 614 hypertensive laboratory-confirmed COVID-19 patients.

METHODS

Demographics, comorbidities, vital signs, laboratory data, and ACEi/ARB usage were analyzed. To account for confounders, patients were substratified by whether they developed hypotension and acute kidney injury (AKI) during the index hospitalization.

RESULTS

Mortality (22% vs 17%, P > .05) and intensive care unit (ICU) admission (26% vs 12%, P > .05) rates were not significantly different between non-ACEi/ARB and ACEi/ARB groups. However, patients who continued ACEi/ARBs in the hospital had a markedly lower ICU admission rate (12% vs 26%; P = .001; odds ratio [OR] = 0.347; 95% confidence interval [CI], .187-.643) and mortality rate (6% vs 28%; P = .001; OR = 0.215; 95% CI, .101-.455) compared to patients who discontinued ACEi/ARB. The odds ratio for mortality remained significantly lower after accounting for development of hypotension or AKI.

CONCLUSIONS

These findings suggest that continued ACEi/ARB use in hypertensive COVID-19 patients yields better clinical outcomes.

Authors+Show Affiliations

Department of Radiology, Renaissance School of Medicine, Stony Brook University, New York, New York, USA.Department of Radiology, Renaissance School of Medicine, Stony Brook University, New York, New York, USA.Department of Radiology, Renaissance School of Medicine, Stony Brook University, New York, New York, USA.Department of Radiology, Renaissance School of Medicine, Stony Brook University, New York, New York, USA.Department of Radiology, Renaissance School of Medicine, Stony Brook University, New York, New York, USA.Department of Medicine, Renaissance School of Medicine, Stony Brook University, New York, New York, USA.Department of Medicine, Renaissance School of Medicine, Stony Brook University, New York, New York, USA.Department of Medicine, Renaissance School of Medicine, Stony Brook University, New York, New York, USA.Department of Emergency Medicine, Renaissance School of Medicine, Stony Brook University, New York, New York, USA.Department of Radiology, Renaissance School of Medicine, Stony Brook University, New York, New York, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32702098

Citation

Lam, Katherine W., et al. "Continued In-Hospital Angiotensin-Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Use in Hypertensive COVID-19 Patients Is Associated With Positive Clinical Outcome." The Journal of Infectious Diseases, vol. 222, no. 8, 2020, pp. 1256-1264.
Lam KW, Chow KW, Vo J, et al. Continued In-Hospital Angiotensin-Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Use in Hypertensive COVID-19 Patients Is Associated With Positive Clinical Outcome. J Infect Dis. 2020;222(8):1256-1264.
Lam, K. W., Chow, K. W., Vo, J., Hou, W., Li, H., Richman, P. S., Mallipattu, S. K., Skopicki, H. A., Singer, A. J., & Duong, T. Q. (2020). Continued In-Hospital Angiotensin-Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Use in Hypertensive COVID-19 Patients Is Associated With Positive Clinical Outcome. The Journal of Infectious Diseases, 222(8), 1256-1264. https://doi.org/10.1093/infdis/jiaa447
Lam KW, et al. Continued In-Hospital Angiotensin-Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Use in Hypertensive COVID-19 Patients Is Associated With Positive Clinical Outcome. J Infect Dis. 2020 09 14;222(8):1256-1264. PubMed PMID: 32702098.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Continued In-Hospital Angiotensin-Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Use in Hypertensive COVID-19 Patients Is Associated With Positive Clinical Outcome. AU - Lam,Katherine W, AU - Chow,Kenneth W, AU - Vo,Jonathan, AU - Hou,Wei, AU - Li,Haifang, AU - Richman,Paul S, AU - Mallipattu,Sandeep K, AU - Skopicki,Hal A, AU - Singer,Adam J, AU - Duong,Tim Q, PY - 2020/06/17/received PY - 2020/07/17/accepted PY - 2020/7/24/pubmed PY - 2020/10/2/medline PY - 2020/7/24/entrez KW - acute kidney injury KW - angiotensin II receptor blockers KW - angiotensin-converting enzyme inhibitors KW - hypotension KW - troponin SP - 1256 EP - 1264 JF - The Journal of infectious diseases JO - J Infect Dis VL - 222 IS - 8 N2 - BACKGROUND: This study investigated continued and discontinued use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB) during hospitalization of 614 hypertensive laboratory-confirmed COVID-19 patients. METHODS: Demographics, comorbidities, vital signs, laboratory data, and ACEi/ARB usage were analyzed. To account for confounders, patients were substratified by whether they developed hypotension and acute kidney injury (AKI) during the index hospitalization. RESULTS: Mortality (22% vs 17%, P > .05) and intensive care unit (ICU) admission (26% vs 12%, P > .05) rates were not significantly different between non-ACEi/ARB and ACEi/ARB groups. However, patients who continued ACEi/ARBs in the hospital had a markedly lower ICU admission rate (12% vs 26%; P = .001; odds ratio [OR] = 0.347; 95% confidence interval [CI], .187-.643) and mortality rate (6% vs 28%; P = .001; OR = 0.215; 95% CI, .101-.455) compared to patients who discontinued ACEi/ARB. The odds ratio for mortality remained significantly lower after accounting for development of hypotension or AKI. CONCLUSIONS: These findings suggest that continued ACEi/ARB use in hypertensive COVID-19 patients yields better clinical outcomes. SN - 1537-6613 UR - https://www.unboundmedicine.com/medline/citation/32702098/Continued_In_Hospital_Angiotensin_Converting_Enzyme_Inhibitor_and_Angiotensin_II_Receptor_Blocker_Use_in_Hypertensive_COVID_19_Patients_Is_Associated_With_Positive_Clinical_Outcome_ L2 - https://academic.oup.com/jid/article-lookup/doi/10.1093/infdis/jiaa447 DB - PRIME DP - Unbound Medicine ER -