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Association of Renin Angiotensin Aldosterone System Inhibitors and Outcomes of Hospitalized Patients With COVID-19.

Publication ,  Journal Article
Gupta, N; Settle, L; Brown, BR; Armaignac, DL; Baram, M; Perkins, NE; Kaufman, M; Melamed, RR; Christie, AB; Danesh, VC; Denson, JL; Boman, K ...
Published in: Crit Care Med
October 1, 2022

OBJECTIVES: To determine the association of prior use of renin-angiotensin-aldosterone system inhibitors (RAASIs) with mortality and outcomes in hospitalized patients with COVID-19. DESIGN: Retrospective observational study. SETTING: Multicenter, international COVID-19 registry. SUBJECTS: Adult hospitalized COVID-19 patients on antihypertensive agents (AHAs) prior to admission, admitted from March 31, 2020, to March 10, 2021. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data were compared between three groups: patients on RAASIs only, other AHAs only, and those on both medications. Multivariable logistic and linear regressions were performed after controlling for prehospitalization characteristics to estimate the effect of RAASIs on mortality and other outcomes during hospitalization. Of 26,652 patients, 7,975 patients were on AHAs prior to hospitalization. Of these, 1,542 patients (19.3%) were on RAASIs only, 3,765 patients (47.2%) were on other AHAs only, and 2,668 (33.5%) patients were on both medications. Compared with those taking other AHAs only, patients on RAASIs only were younger (mean age 63.3 vs 66.9 yr; p < 0.0001), more often male (58.2% vs 52.4%; p = 0.0001) and more often White (55.1% vs 47.2%; p < 0.0001). After adjusting for age, gender, race, location, and comorbidities, patients on combination of RAASIs and other AHAs had higher in-hospital mortality than those on RAASIs only (odds ratio [OR] = 1.28; 95% CI [1.19-1.38]; p < 0.0001) and higher mortality than those on other AHAs only (OR = 1.09; 95% CI [1.03-1.15]; p = 0.0017). Patients on RAASIs only had lower mortality than those on other AHAs only (OR = 0.87; 95% CI [0.81-0.94]; p = 0.0003). Patients on ACEIs only had higher mortality compared with those on ARBs only (OR = 1.37; 95% CI [1.20-1.56]; p < 0.0001). CONCLUSIONS: Among patients hospitalized for COVID-19 who were taking AHAs, prior use of a combination of RAASIs and other AHAs was associated with higher in-hospital mortality than the use of RAASIs alone. When compared with ARBs, ACEIs were associated with significantly higher mortality in hospitalized COVID-19 patients.

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Published In

Crit Care Med

DOI

EISSN

1530-0293

Publication Date

October 1, 2022

Volume

50

Issue

10

Start / End Page

e744 / e758

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Renin-Angiotensin System
  • Middle Aged
  • Male
  • Hypertension
  • Humans
  • Emergency & Critical Care Medicine
  • COVID-19 Drug Treatment
  • Antihypertensive Agents
  • Angiotensin-Converting Enzyme Inhibitors
 

Citation

APA
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Gupta, N., Settle, L., Brown, B. R., Armaignac, D. L., Baram, M., Perkins, N. E., … Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator Group, . (2022). Association of Renin Angiotensin Aldosterone System Inhibitors and Outcomes of Hospitalized Patients With COVID-19. Crit Care Med, 50(10), e744–e758. https://doi.org/10.1097/CCM.0000000000005627
Gupta, Neha, Lisa Settle, Brent R. Brown, Donna L. Armaignac, Michael Baram, Nicholas E. Perkins, Margit Kaufman, et al. “Association of Renin Angiotensin Aldosterone System Inhibitors and Outcomes of Hospitalized Patients With COVID-19.Crit Care Med 50, no. 10 (October 1, 2022): e744–58. https://doi.org/10.1097/CCM.0000000000005627.
Gupta N, Settle L, Brown BR, Armaignac DL, Baram M, Perkins NE, et al. Association of Renin Angiotensin Aldosterone System Inhibitors and Outcomes of Hospitalized Patients With COVID-19. Crit Care Med. 2022 Oct 1;50(10):e744–58.
Gupta, Neha, et al. “Association of Renin Angiotensin Aldosterone System Inhibitors and Outcomes of Hospitalized Patients With COVID-19.Crit Care Med, vol. 50, no. 10, Oct. 2022, pp. e744–58. Pubmed, doi:10.1097/CCM.0000000000005627.
Gupta N, Settle L, Brown BR, Armaignac DL, Baram M, Perkins NE, Kaufman M, Melamed RR, Christie AB, Danesh VC, Denson JL, Cheruku SR, Boman K, Bansal V, Kumar VK, Walkey AJ, Domecq JP, Kashyap R, Aston CE, Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator Group. Association of Renin Angiotensin Aldosterone System Inhibitors and Outcomes of Hospitalized Patients With COVID-19. Crit Care Med. 2022 Oct 1;50(10):e744–e758.

Published In

Crit Care Med

DOI

EISSN

1530-0293

Publication Date

October 1, 2022

Volume

50

Issue

10

Start / End Page

e744 / e758

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Renin-Angiotensin System
  • Middle Aged
  • Male
  • Hypertension
  • Humans
  • Emergency & Critical Care Medicine
  • COVID-19 Drug Treatment
  • Antihypertensive Agents
  • Angiotensin-Converting Enzyme Inhibitors