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Renin-Angiotensin System Blockers and Adverse Outcomes of Influenza and Pneumonia: A Danish Cohort Study.
- Source :
-
Journal of the American Heart Association [J Am Heart Assoc] 2020 Oct 20; Vol. 9 (19), pp. e017297. Date of Electronic Publication: 2020 Oct 01. - Publication Year :
- 2020
-
Abstract
- Background Angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) may worsen the prognosis of coronavirus disease 2019, but any association could be confounded by the cardiometabolic conditions indicating ACE-I/ARB use. We therefore examined the impact of ACE-Is/ARBs on respiratory tract infection outcomes. Methods and Results This cohort study included all adult patients hospitalized with influenza or pneumonia from 2005 to 2018 in Denmark using population-based medical databases. Thirty-day mortality and risk of admission to the intensive care unit in ACE-Is/ARBs users was compared with nonusers and with users of calcium channel blockers. We used propensity scores to handle confounding and computed propensity score-weighted risks, risk differences (RDs), and risk ratios (RRs). Of 568 019 patients hospitalized with influenza or pneumonia, 100 278 were ACE-I/ARB users and 37 961 were users of calcium channel blockers. In propensity score-weighted analyses, ACE-I/ARB users had marginally lower 30-day mortality than users of calcium channel blockers (13.9% versus 14.5%; RD, -0.6%; 95% CI, -1.0 to -0.1; RR, 0.96; 95% CI, 0.93-0.99), and a lower risk of admission to the intensive care unit (8.0% versus 9.6%; RD, -1.6%; 95% CI, -2.0 to -1.2; RR, 0.83; 95% CI, 0.80-0.87). Compared with nonusers, current ACE-I/ARB users had lower mortality (RD, -2.4%; 95% CI, -2.8 to -2.0; RR, 0.85; 95% CI, 0.83-0.87), but similar risk of admission to the intensive care unit (RD, 0.4%; 95% CI, 0.0-0.7; RR, 1.04; 95% CI, 1.00-1.09). Conclusions Among patients with influenza or pneumonia, ACE-I/ARB users had no increased risk of admission to the intensive care unit and slightly reduced mortality after controlling for confounding.
- Subjects :
- Aged
Aged, 80 and over
COVID-19
Denmark epidemiology
Female
Follow-Up Studies
Humans
Incidence
Influenza, Human epidemiology
Male
Odds Ratio
Pandemics
Pneumonia epidemiology
Propensity Score
Retrospective Studies
SARS-CoV-2
Survival Rate trends
Angiotensin Receptor Antagonists therapeutic use
Angiotensin-Converting Enzyme Inhibitors therapeutic use
Betacoronavirus
Coronavirus Infections drug therapy
Influenza, Human drug therapy
Pneumonia drug therapy
Pneumonia, Viral drug therapy
Renin-Angiotensin System drug effects
Subjects
Details
- Language :
- English
- ISSN :
- 2047-9980
- Volume :
- 9
- Issue :
- 19
- Database :
- MEDLINE
- Journal :
- Journal of the American Heart Association
- Publication Type :
- Academic Journal
- Accession number :
- 32998607
- Full Text :
- https://doi.org/10.1161/JAHA.120.017297