Association of outpatient use of renin–angiotensin–aldosterone system blockers on outcomes of acute respiratory illness during the COVID-19 pandemic: a cohort study
Objectives Evaluate the associations between patients taking ACE inhibitors and angiotensin receptor blockers (ARBs) and their clinical outcomes after an acute viral respiratory illness (AVRI) due to COVID-19.Design Retrospective cohort.Setting The USA; 2017–2018 influenza season, 2018–2019 influenz...
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| Format: | Article |
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BMJ Publishing Group
2022-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/7/e060305.full |
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| author | Molly Moore Jeffery Lucas Oliveira J e Silva Fernanda Bellolio Nathan W Cummins Timothy M Dempsey Vesna D Garovic Andrew Limper |
| author_facet | Molly Moore Jeffery Lucas Oliveira J e Silva Fernanda Bellolio Nathan W Cummins Timothy M Dempsey Vesna D Garovic Andrew Limper |
| author_sort | Molly Moore Jeffery |
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| description | Objectives Evaluate the associations between patients taking ACE inhibitors and angiotensin receptor blockers (ARBs) and their clinical outcomes after an acute viral respiratory illness (AVRI) due to COVID-19.Design Retrospective cohort.Setting The USA; 2017–2018 influenza season, 2018–2019 influenza season, and 2019–2020 influenza/COVID-19 season.Participants People with hypertension (HTN) taking an ACEi, ARB or other HTN medications, and experiencing AVRI.Main outcome measures Change in hospital admission, intensive care unit (ICU) or coronary care unit (CCU), acute respiratory distress (ARD), ARD syndrome (ARDS) and all-cause mortality, comparing COVID-19 to pre-COVID-19 influenza seasons.Results The cohort included 1 059 474 episodes of AVRI (653 797 filled an ACEi or ARB, and 405 677 other HTN medications). 58.6% were women and 72.9% with age ≥65. The ACEi/ARB cohort saw a larger increase in risk in the COVID-19 influenza season than the other HTN medication cohort for four out of five outcomes, with an additional 1.5 percentage point (pp) increase in risk of an inpatient stay (95% CI 1.2 to 1.9 pp) and of ICU/CCU use (95% CI 0.3 to 2.7 pp) as well as a 0.7 pp (0.1 to 1.2 pp) additional increase in risk of ARD and 0.9 pp (0.4 to 1.3 pp) additional increase in risk of ARDS. There was no statistically significant difference in the absolute risk of death (−0.2 pp, 95% CI −0.4 to 0.1 pp). However, the relative risk of death in 2019/2020 versus 2017/2018 for the ACEi/ARB group was larger (1.40 (1.36 to 1.44)) than for the other HTN medication cohort (1.24 (1.21 to 1.28)).Conclusions People with AVRI using ACEi/ARBs for HTN had a greater increase in poor outcomes during the COVID-19 pandemic than those using other medications to treat HTN. The small absolute magnitude of the differences likely does not support changes in clinical practice. |
| format | Article |
| id | doaj-art-01cac24c43d947158fb04132bc066467 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-07-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-01cac24c43d947158fb04132bc0664672025-01-31T07:25:09ZengBMJ Publishing GroupBMJ Open2044-60552022-07-0112710.1136/bmjopen-2021-060305Association of outpatient use of renin–angiotensin–aldosterone system blockers on outcomes of acute respiratory illness during the COVID-19 pandemic: a cohort studyMolly Moore Jeffery0Lucas Oliveira J e Silva1Fernanda Bellolio2Nathan W Cummins3Timothy M Dempsey4Vesna D Garovic5Andrew Limper6Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USAEmergency Medicine, Mayo Clinic, Rochester, Minnesota, USAEmergency Medicine and Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota, USADepartment of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USADavid Grant Medical Center, US Air Force, Travis Air Force Base, California, USADepartment of Medicine, Division of Nephrology & Hypertension, Mayo Clinic, Rochester, Minnesota, USARobert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USAObjectives Evaluate the associations between patients taking ACE inhibitors and angiotensin receptor blockers (ARBs) and their clinical outcomes after an acute viral respiratory illness (AVRI) due to COVID-19.Design Retrospective cohort.Setting The USA; 2017–2018 influenza season, 2018–2019 influenza season, and 2019–2020 influenza/COVID-19 season.Participants People with hypertension (HTN) taking an ACEi, ARB or other HTN medications, and experiencing AVRI.Main outcome measures Change in hospital admission, intensive care unit (ICU) or coronary care unit (CCU), acute respiratory distress (ARD), ARD syndrome (ARDS) and all-cause mortality, comparing COVID-19 to pre-COVID-19 influenza seasons.Results The cohort included 1 059 474 episodes of AVRI (653 797 filled an ACEi or ARB, and 405 677 other HTN medications). 58.6% were women and 72.9% with age ≥65. The ACEi/ARB cohort saw a larger increase in risk in the COVID-19 influenza season than the other HTN medication cohort for four out of five outcomes, with an additional 1.5 percentage point (pp) increase in risk of an inpatient stay (95% CI 1.2 to 1.9 pp) and of ICU/CCU use (95% CI 0.3 to 2.7 pp) as well as a 0.7 pp (0.1 to 1.2 pp) additional increase in risk of ARD and 0.9 pp (0.4 to 1.3 pp) additional increase in risk of ARDS. There was no statistically significant difference in the absolute risk of death (−0.2 pp, 95% CI −0.4 to 0.1 pp). However, the relative risk of death in 2019/2020 versus 2017/2018 for the ACEi/ARB group was larger (1.40 (1.36 to 1.44)) than for the other HTN medication cohort (1.24 (1.21 to 1.28)).Conclusions People with AVRI using ACEi/ARBs for HTN had a greater increase in poor outcomes during the COVID-19 pandemic than those using other medications to treat HTN. The small absolute magnitude of the differences likely does not support changes in clinical practice.https://bmjopen.bmj.com/content/12/7/e060305.full |
| spellingShingle | Molly Moore Jeffery Lucas Oliveira J e Silva Fernanda Bellolio Nathan W Cummins Timothy M Dempsey Vesna D Garovic Andrew Limper Association of outpatient use of renin–angiotensin–aldosterone system blockers on outcomes of acute respiratory illness during the COVID-19 pandemic: a cohort study BMJ Open |
| title | Association of outpatient use of renin–angiotensin–aldosterone system blockers on outcomes of acute respiratory illness during the COVID-19 pandemic: a cohort study |
| title_full | Association of outpatient use of renin–angiotensin–aldosterone system blockers on outcomes of acute respiratory illness during the COVID-19 pandemic: a cohort study |
| title_fullStr | Association of outpatient use of renin–angiotensin–aldosterone system blockers on outcomes of acute respiratory illness during the COVID-19 pandemic: a cohort study |
| title_full_unstemmed | Association of outpatient use of renin–angiotensin–aldosterone system blockers on outcomes of acute respiratory illness during the COVID-19 pandemic: a cohort study |
| title_short | Association of outpatient use of renin–angiotensin–aldosterone system blockers on outcomes of acute respiratory illness during the COVID-19 pandemic: a cohort study |
| title_sort | association of outpatient use of renin angiotensin aldosterone system blockers on outcomes of acute respiratory illness during the covid 19 pandemic a cohort study |
| url | https://bmjopen.bmj.com/content/12/7/e060305.full |
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