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Renin-angiotensin system inhibitors and the severity of coronavirus disease 2019 in Kanagawa, Japan: a retrospective cohort study.
Hypertens Res. 2020 11; 43(11):1257-1266.HR

Abstract

Since the beginning of the coronavirus disease 2019 (COVID-19) outbreak initiated on the Diamond Princess Cruise Ship at Yokohama harbor in February 2020, we have been doing our best to treat COVID-19 patients. In animal experiments, angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II type-1 receptor blockers (ARBs) are reported to suppress the downregulation of angiotensin converting enzyme 2 (ACE2), and they may inhibit the worsening of pathological conditions. We aimed to examine whether preceding use of ACEIs and ARBs affected the clinical manifestations and prognosis of COVID-19 patients. One hundred fifty-one consecutive patients (mean age 60 ± 19 years) with polymerase-chain-reaction proven severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who were admitted to six hospitals in Kanagawa Prefecture, Japan, were analyzed in this multicenter retrospective observational study. Among all COVID-19 patients, in the multiple regression analysis, older age (age ≥ 65 years) was significantly associated with the primary composite outcome (odds ratio (OR) 6.63, 95% confidence interval (CI) 2.28-22.78, P < 0.001), which consisted of (i) in-hospital death, (ii) extracorporeal membrane oxygenation, (iii) mechanical ventilation, including invasive and noninvasive methods, and (iv) admission to the intensive care unit. In COVID-19 patients with hypertension, preceding ACEI/ARB use was significantly associated with a lower occurrence of new-onset or worsening mental confusion (OR 0.06, 95% CI 0.002-0.69, P = 0.02), which was defined by the confusion criterion, which included mild disorientation or hallucination with an estimation of medical history of mental status, after adjustment for age, sex, and diabetes. In conclusion, older age was a significant contributor to a worse prognosis in COVID-19 patients, and ACEIs/ARBs could be beneficial for the prevention of confusion in COVID-19 patients with hypertension.

Authors+Show Affiliations

Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan. matsu@yokohama-cu.ac.jp.National Cerebral and Cardiovascular Center, Suita, Japan.Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan.Division of Cardiology, Fujisawa City Hospital, Fujisawa, Japan.Department of Clinical Laboratory Medicine, Fujisawa City Hospital, Fujisawa, Japan.Department of General Medicine, Kanagawa Prefectural Ashigarakami Hospital, Ashigara, Japan.Division of Cardiology, Kanagawa Prefectural Ashigarakami Hospital, Ashigara, Japan.Division of Cardiology, Yokosuka City Hospital, Yokosuka, Japan.Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.Headquarters, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan.Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.

Pub Type(s)

Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32820236

Citation

Matsuzawa, Yasushi, et al. "Renin-angiotensin System Inhibitors and the Severity of Coronavirus Disease 2019 in Kanagawa, Japan: a Retrospective Cohort Study." Hypertension Research : Official Journal of the Japanese Society of Hypertension, vol. 43, no. 11, 2020, pp. 1257-1266.
Matsuzawa Y, Ogawa H, Kimura K, et al. Renin-angiotensin system inhibitors and the severity of coronavirus disease 2019 in Kanagawa, Japan: a retrospective cohort study. Hypertens Res. 2020;43(11):1257-1266.
Matsuzawa, Y., Ogawa, H., Kimura, K., Konishi, M., Kirigaya, J., Fukui, K., Tsukahara, K., Shimizu, H., Iwabuchi, K., Yamada, Y., Saka, K., Takeuchi, I., Hirano, T., & Tamura, K. (2020). Renin-angiotensin system inhibitors and the severity of coronavirus disease 2019 in Kanagawa, Japan: a retrospective cohort study. Hypertension Research : Official Journal of the Japanese Society of Hypertension, 43(11), 1257-1266. https://doi.org/10.1038/s41440-020-00535-8
Matsuzawa Y, et al. Renin-angiotensin System Inhibitors and the Severity of Coronavirus Disease 2019 in Kanagawa, Japan: a Retrospective Cohort Study. Hypertens Res. 2020;43(11):1257-1266. PubMed PMID: 32820236.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Renin-angiotensin system inhibitors and the severity of coronavirus disease 2019 in Kanagawa, Japan: a retrospective cohort study. AU - Matsuzawa,Yasushi, AU - Ogawa,Hisao, AU - Kimura,Kazuo, AU - Konishi,Masaaki, AU - Kirigaya,Jin, AU - Fukui,Kazuki, AU - Tsukahara,Kengo, AU - Shimizu,Hiroyuki, AU - Iwabuchi,Keisuke, AU - Yamada,Yu, AU - Saka,Kenichiro, AU - Takeuchi,Ichiro, AU - Hirano,Toshio, AU - Tamura,Kouichi, Y1 - 2020/08/21/ PY - 2020/07/02/received PY - 2020/07/15/accepted PY - 2020/07/15/revised PY - 2020/8/21/pubmed PY - 2020/10/28/medline PY - 2020/8/22/entrez KW - Angiotensin II type-1 receptor blockers KW - Angiotensin converting enzyme inhibitors KW - COVID-19 SP - 1257 EP - 1266 JF - Hypertension research : official journal of the Japanese Society of Hypertension JO - Hypertens Res VL - 43 IS - 11 N2 - Since the beginning of the coronavirus disease 2019 (COVID-19) outbreak initiated on the Diamond Princess Cruise Ship at Yokohama harbor in February 2020, we have been doing our best to treat COVID-19 patients. In animal experiments, angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II type-1 receptor blockers (ARBs) are reported to suppress the downregulation of angiotensin converting enzyme 2 (ACE2), and they may inhibit the worsening of pathological conditions. We aimed to examine whether preceding use of ACEIs and ARBs affected the clinical manifestations and prognosis of COVID-19 patients. One hundred fifty-one consecutive patients (mean age 60 ± 19 years) with polymerase-chain-reaction proven severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who were admitted to six hospitals in Kanagawa Prefecture, Japan, were analyzed in this multicenter retrospective observational study. Among all COVID-19 patients, in the multiple regression analysis, older age (age ≥ 65 years) was significantly associated with the primary composite outcome (odds ratio (OR) 6.63, 95% confidence interval (CI) 2.28-22.78, P < 0.001), which consisted of (i) in-hospital death, (ii) extracorporeal membrane oxygenation, (iii) mechanical ventilation, including invasive and noninvasive methods, and (iv) admission to the intensive care unit. In COVID-19 patients with hypertension, preceding ACEI/ARB use was significantly associated with a lower occurrence of new-onset or worsening mental confusion (OR 0.06, 95% CI 0.002-0.69, P = 0.02), which was defined by the confusion criterion, which included mild disorientation or hallucination with an estimation of medical history of mental status, after adjustment for age, sex, and diabetes. In conclusion, older age was a significant contributor to a worse prognosis in COVID-19 patients, and ACEIs/ARBs could be beneficial for the prevention of confusion in COVID-19 patients with hypertension. SN - 1348-4214 UR - https://www.unboundmedicine.com/medline/citation/32820236/Renin_angiotensin_system_inhibitors_and_the_severity_of_coronavirus_disease_2019_in_Kanagawa_Japan:_a_retrospective_cohort_study_ L2 - https://medlineplus.gov/highbloodpressure.html DB - PRIME DP - Unbound Medicine ER -