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《NEJM，5月1日，Renin–Angiotensin–Aldosterone System Inhibitors and Risk of Covid-19》

  • 来源专题：COVID-19科研动态监测
  • 编译者： zhangmin
  • 发布时间：2020-05-02

  • Renin–Angiotensin–Aldosterone System Inhibitors and Risk of Covid-19

    List of authors.

    Harmony R. Reynolds, M.D., Samrachana Adhikari, Ph.D., Claudia Pulgarin, M.A., M.S., Andrea B. Troxel, Sc.D., Eduardo Iturrate, M.D., M.S.W., Stephen B. Johnson, Ph.D., Anaïs Hausvater, M.D., Jonathan D. Newman, M.D., M.P.H., Jeffrey S. Berger, M.D., Sripal Bangalore, M.D., Stuart D. Katz, M.D., Glenn I. Fishman, M.D., et al.

    Abstract

    BACKGROUND

    There is concern about the potential of an increased risk related to medications that act on the renin–angiotensin–aldosterone system in patients exposed to coronavirus disease 2019 (Covid-19), because the viral receptor is angiotensin-converting enzyme 2 (ACE2).

    METHODS

    We assessed the relation between previous treatment with ACE inhibitors, angiotensin-receptor blockers, beta-blockers, calcium-channel blockers, or thiazide diuretics and the likelihood of a positive or negative result on Covid-19 testing as well as the likelihood of severe illness (defined as intensive care, mechanical ventilation, or death) among patients who tested positive. Using Bayesian methods, we compared outcomes in patients who had been treated with these medications and in untreated patients, overall and in those with hypertension, after propensity-score matching for receipt of each medication class. A difference of at least 10 percentage points was prespecified as a substantial difference.

  • 原文来源：https://www.nejm.org/doi/full/10.1056/NEJMoa2008975
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  • 《NEJM，3月30日，Renin–Angiotensin–Aldosterone System Inhibitors in Patients with Covid-19》
    • 来源专题：COVID-19科研动态监测
    • 编译者：zhangmin
    • 发布时间：2020-04-06
    • Renin–Angiotensin–Aldosterone System Inhibitors in Patients with Covid-19 List of authors. Muthiah Vaduganathan, M.D., M.P.H., Orly Vardeny, Pharm.D., Thomas Michel, M.D., Ph.D., John J.V. McMurray, M.D., Marc A. Pfeffer, M.D., Ph.D., and Scott D. Solomon, M.D. The renin–angiotensin–aldosterone system (RAAS) is an elegant cascade of vasoactive peptides that orchestrate key processes in human physiology. Severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) and SARS-CoV-2, which have been responsible for the SARS epidemic in 2002 to 2004 and for the more recent coronavirus disease 2019 (Covid-19) pandemic, respectively, interface with the RAAS through angiotensin-converting enzyme 2 (ACE2), an enzyme that physiologically counters RAAS activation but also functions as a receptor for both SARS viruses.1,2 The interaction between the SARS viruses and ACE2 has been proposed as a potential factor in their infectivity,3,4 and there are concerns about the use of RAAS inhibitors that may alter ACE2 and whether variation in ACE2 expression may be in part responsible for disease virulence in the ongoing Covid-19 pandemic.
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  • 《LANCET，5月14日，Use of renin–angiotensin–aldosterone system inhibitors and risk of COVID-19 requiring admission to hospital: a case-population study》
    • 来源专题：COVID-19科研动态监测
    • 编译者：xuwenwhlib
    • 发布时间：2020-05-15
    • Use of renin–angiotensin–aldosterone system inhibitors and risk of COVID-19 requiring admission to hospital: a case-population study Prof Francisco J de Abajo, PhD Sara Rodríguez-Martín, PhD Victoria Lerma, RN Gina Mejía-Abril, MD Mónica Aguilar, MD Amelia García-Luque, PhD et al. Show all authors Show footnotes Published:May 14, 2020DOI:https://doi.org/10.1016/S0140-6736(20)31030-8 Background Concerns have been raised about the possibility that inhibitors of the renin–angiotensin–aldosterone system (RAAS) could predispose individuals to severe COVID-19; however, epidemiological evidence is lacking. We report the results of a case-population study done in Madrid, Spain, since the outbreak of COVID-19. Methods In this case-population study, we consecutively selected patients aged 18 years or older with a PCR-confirmed diagnosis of COVID-19 requiring admission to hospital from seven hospitals in Madrid, who had been admitted between March 1 and March 24, 2020. As a reference group, we randomly sampled ten patients per case, individually matched for age, sex, region (ie, Madrid), and date of admission to hospital (month and day; index date), from Base de datos para la Investigación Farmacoepidemiológica en Atención Primaria (BIFAP), a Spanish primary health-care database, in its last available year (2018). We extracted information on comorbidities and prescriptions up to the month before index date (ie, current use) from electronic clinical records of both cases and controls. The outcome of interest was admission to hospital of patients with COVID-19. To minimise confounding by indication, the main analysis focused on assessing the association between COVID-19 requiring admission to hospital and use of RAAS inhibitors compared with use of other antihypertensive drugs. We calculated odds ratios (ORs) and 95% CIs, adjusted for age, sex, and cardiovascular comorbidities and risk factors, using conditional logistic regression. The protocol of the study was registered in the EU electronic Register of Post-Authorisation Studies, EUPAS34437.
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