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10.1136/heartjnl-2020-317393

http://scihub22266oqcxt.onion/10.1136/heartjnl-2020-317393
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32737124!7509391!32737124
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suck abstract from ncbi


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pmid32737124      Heart 2020 ; 106 (19): 1503-1511
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  • Risk of severe COVID-19 disease with ACE inhibitors and angiotensin receptor blockers: cohort study including 8 3 million people #MMPMID32737124
  • Hippisley-Cox J; Young D; Coupland C; Channon KM; Tan PS; Harrison DA; Rowan K; Aveyard P; Pavord ID; Watkinson PJ
  • Heart 2020[Oct]; 106 (19): 1503-1511 PMID32737124show ga
  • BACKGROUND: There is uncertainty about the associations of angiotensive enzyme (ACE) inhibitor and angiotensin receptor blocker (ARB) drugs with COVID-19 disease. We studied whether patients prescribed these drugs had altered risks of contracting severe COVID-19 disease and receiving associated intensive care unit (ICU) admission. METHODS: This was a prospective cohort study using routinely collected data from 1205 general practices in England with 8.28 million participants aged 20-99 years. We used Cox proportional hazards models to derive adjusted HRs for exposure to ACE inhibitor and ARB drugs adjusted for sociodemographic factors, concurrent medications and geographical region. The primary outcomes were: (a) COVID-19 RT-PCR diagnosed disease and (b) COVID-19 disease resulting in ICU care. FINDINGS: Of 19 486 patients who had COVID-19 disease, 1286 received ICU care. ACE inhibitors were associated with a significantly reduced risk of COVID-19 disease (adjusted HR 0.71, 95% CI 0.67 to 0.74) but no increased risk of ICU care (adjusted HR 0.89, 95% CI 0.75 to 1.06) after adjusting for a wide range of confounders. Adjusted HRs for ARBs were 0.63 (95% CI 0.59 to 0.67) for COVID-19 disease and 1.02 (95% CI 0.83 to 1.25) for ICU care.There were significant interactions between ethnicity and ACE inhibitors and ARBs for COVID-19 disease. The risk of COVID-19 disease associated with ACE inhibitors was higher in Caribbean (adjusted HR 1.05, 95% CI 0.87 to 1.28) and Black African (adjusted HR 1.31, 95% CI 1.08 to 1.59) groups than the white group (adjusted HR 0.66, 95% CI 0.63 to 0.70). A higher risk of COVID-19 with ARBs was seen for Black African (adjusted HR 1.24, 95% CI 0.99 to 1.58) than the white (adjusted HR 0.56, 95% CI 0.52 to 0.62) group. INTERPRETATION: ACE inhibitors and ARBs are associated with reduced risks of COVID-19 disease after adjusting for a wide range of variables. Neither ACE inhibitors nor ARBs are associated with significantly increased risks of receiving ICU care. Variations between different ethnic groups raise the possibility of ethnic-specific effects of ACE inhibitors/ARBs on COVID-19 disease susceptibility and severity which deserves further study.
  • |*Betacoronavirus[MESH]
  • |Adult[MESH]
  • |Aged[MESH]
  • |Aged, 80 and over[MESH]
  • |Angiotensin Receptor Antagonists/*therapeutic use[MESH]
  • |Angiotensin-Converting Enzyme Inhibitors/*therapeutic use[MESH]
  • |COVID-19[MESH]
  • |Cohort Studies[MESH]
  • |Coronavirus Infections/diagnosis/*epidemiology[MESH]
  • |Critical Care/statistics & numerical data[MESH]
  • |England/epidemiology[MESH]
  • |Health Status[MESH]
  • |Hospitalization/statistics & numerical data[MESH]
  • |Humans[MESH]
  • |Middle Aged[MESH]
  • |Pandemics[MESH]
  • |Pneumonia, Viral/diagnosis/*epidemiology[MESH]
  • |Risk Factors[MESH]
  • |SARS-CoV-2[MESH]
  • |Socioeconomic Factors[MESH]


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