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[Association of hypertension and antihypertensive agents and the severity of COVID-19 pneumonia. A monocentric French prospective study].
Ann Cardiol Angeiol (Paris). 2020 Nov; 69(5):247-254.AC

Abstract

BACKGROUND AND AIM

Angiotensin converting enzyme (ACE) type 2 is the receptor of SARSCoV-2 for cell entry into lung cells. Because ACE-2 may be modulated by ACE inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), there are concern that patients treated with ACEIs and ARBs are at higher risk for COVID-19 infection or severity. This study sought to analyse the association of severe forms of COVID-19 and mortality with hypertension and a previous treatment with ACEI and ARB.

METHODS

Prospective follow-up of 433 consecutive patients hospitalised for COVID-19 pneumonia confirmed by PCR or highly probable on clinical, biological, and radiological findings, and included in the COVHYP study. Mortality and severe COVID-19 (criteria: death, intensive care unit, or hospitalisation >30 days) were compared in patients receiving or not ACEIs and ARBs. Follow-up was 100% at hospital discharge, and 96.5% at >1month.

RESULTS

Age was 63.6±18.7 years, and 40%) were female. At follow-up (mean 78±50 days), 136 (31%) patients had severity criteria (death, 64 ; intensive care unit, 73; hospital stay >30 days, 49). Hypertension (55.1% vs 36.7%, P<0.001) and antihypertensive treatment were associated with severe COVID-19 and mortality. The association between ACEI/ARB treatment and COVID-19 severity criteria found in univariate analysis (Odds Ratio 1.74, 95%CI [1.14-2.64], P=0.01) was not confirmed when adjusted on age, gender, and hypertension (adjusted OR1.13 [0.59-2.15], P=0.72). Diabetes and hypothyroidism were associated with severe COVID-19, whereas history of asthma was not.

CONCLUSION

This study suggests that previous treatment with ACEI and ARB is not associated with hospital mortality, 1- and 2-month mortality, and severity criteria in patients hospitalised for COVID-19. No protective effect of ACEIs and ARBs on severe pneumonia related to COVID-19 was demonstrated.

Links

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Authors+Show Affiliations

Georges JL
Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France. Electronic address: jgeorges@ch-versailles.fr.
Cochet H
Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France.
Roger G
Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France.
Ben Jemaa H
Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France.
Soltani J
Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France.
Azowa JB
Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France.
Mamou R
Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France.
Gilles F
Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France.
Saba J
Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France.
Prevot A
Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France.
Pasqualini M
Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France.
Monguillon V
Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France.
De Tournemire M
Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France.
Bertrand A
Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France.
Koukabi-Fradelizi M
Service d'accueil des urgences, Centre Hospitalier de Versailles, Le Chesnay, France.
Beressi JP
Service de diabétologie, Centre Hospitalier de Versailles, Le Chesnay, France.
Livarek B
Service de cardiologie, Centre Hospitalier de Versailles, Le Chesnay, France.

MeSH

AgedAged, 80 and overAnalysis of VarianceAngiotensin II Type 2 Receptor BlockersAngiotensin-Converting Enzyme 2Angiotensin-Converting Enzyme InhibitorsAntihypertensive AgentsBetacoronavirusCOVID-19Coronavirus InfectionsCritical CareDiabetes MellitusFemaleFranceHospitalizationHumansHypertensionHypothyroidismLength of StayMaleMiddle AgedPandemicsPeptidyl-Dipeptidase APneumonia, ViralProspective StudiesRetrospective StudiesSARS-CoV-2Severity of Illness Index

Pub Type(s)

Journal Article

Language

fre

PubMed ID

33039120

Citation

Georges, J-L, et al. "[Association of Hypertension and Antihypertensive Agents and the Severity of COVID-19 Pneumonia. a Monocentric French Prospective Study]." Annales De Cardiologie Et D'angeiologie, vol. 69, no. 5, 2020, pp. 247-254.
Georges JL, Cochet H, Roger G, et al. [Association of hypertension and antihypertensive agents and the severity of COVID-19 pneumonia. A monocentric French prospective study]. Ann Cardiol Angeiol (Paris). 2020;69(5):247-254.
Georges, J. L., Cochet, H., Roger, G., Ben Jemaa, H., Soltani, J., Azowa, J. B., Mamou, R., Gilles, F., Saba, J., Prevot, A., Pasqualini, M., Monguillon, V., De Tournemire, M., Bertrand, A., Koukabi-Fradelizi, M., Beressi, J. P., & Livarek, B. (2020). [Association of hypertension and antihypertensive agents and the severity of COVID-19 pneumonia. A monocentric French prospective study]. Annales De Cardiologie Et D'angeiologie, 69(5), 247-254. https://doi.org/10.1016/j.ancard.2020.09.030
Georges JL, et al. [Association of Hypertension and Antihypertensive Agents and the Severity of COVID-19 Pneumonia. a Monocentric French Prospective Study]. Ann Cardiol Angeiol (Paris). 2020;69(5):247-254. PubMed PMID: 33039120.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Association of hypertension and antihypertensive agents and the severity of COVID-19 pneumonia. A monocentric French prospective study]. AU - Georges,J-L, AU - Cochet,H, AU - Roger,G, AU - Ben Jemaa,H, AU - Soltani,J, AU - Azowa,J-B, AU - Mamou,R, AU - Gilles,F, AU - Saba,J, AU - Prevot,A, AU - Pasqualini,M, AU - Monguillon,V, AU - De Tournemire,M, AU - Bertrand,A, AU - Koukabi-Fradelizi,M, AU - Beressi,J-P, AU - Livarek,B, Y1 - 2020/09/29/ PY - 2020/09/02/received PY - 2020/09/18/accepted PY - 2020/10/12/pubmed PY - 2020/11/12/medline PY - 2020/10/11/entrez KW - Angiotensin II Receptor Blockers KW - Angiotensin-Converting Enzyme Inhibitors KW - Antagoniste des récepteurs à l’Angiotensine II KW - COVID-19 KW - Hypertension KW - Inhibiteurs de l’enzyme de conversion KW - Renin-Angiotensin System KW - Système Rénine-Angiotensine-Aldostérone SP - 247 EP - 254 JF - Annales de cardiologie et d'angeiologie JO - Ann Cardiol Angeiol (Paris) VL - 69 IS - 5 N2 - BACKGROUND AND AIM: Angiotensin converting enzyme (ACE) type 2 is the receptor of SARSCoV-2 for cell entry into lung cells. Because ACE-2 may be modulated by ACE inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), there are concern that patients treated with ACEIs and ARBs are at higher risk for COVID-19 infection or severity. This study sought to analyse the association of severe forms of COVID-19 and mortality with hypertension and a previous treatment with ACEI and ARB. METHODS: Prospective follow-up of 433 consecutive patients hospitalised for COVID-19 pneumonia confirmed by PCR or highly probable on clinical, biological, and radiological findings, and included in the COVHYP study. Mortality and severe COVID-19 (criteria: death, intensive care unit, or hospitalisation >30 days) were compared in patients receiving or not ACEIs and ARBs. Follow-up was 100% at hospital discharge, and 96.5% at >1month. RESULTS: Age was 63.6±18.7 years, and 40%) were female. At follow-up (mean 78±50 days), 136 (31%) patients had severity criteria (death, 64 ; intensive care unit, 73; hospital stay >30 days, 49). Hypertension (55.1% vs 36.7%, P<0.001) and antihypertensive treatment were associated with severe COVID-19 and mortality. The association between ACEI/ARB treatment and COVID-19 severity criteria found in univariate analysis (Odds Ratio 1.74, 95%CI [1.14-2.64], P=0.01) was not confirmed when adjusted on age, gender, and hypertension (adjusted OR1.13 [0.59-2.15], P=0.72). Diabetes and hypothyroidism were associated with severe COVID-19, whereas history of asthma was not. CONCLUSION: This study suggests that previous treatment with ACEI and ARB is not associated with hospital mortality, 1- and 2-month mortality, and severity criteria in patients hospitalised for COVID-19. No protective effect of ACEIs and ARBs on severe pneumonia related to COVID-19 was demonstrated. SN - 1768-3181 UR - https://www.unboundmedicine.com/medline/citation/33039120/[Association_of_hypertension_and_antihypertensive_agents_and_the_severity_of_COVID_19_pneumonia__A_monocentric_French_prospective_study]_ DB - PRIME DP - Unbound Medicine ER -