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10.1097/HJH.0000000000002706

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33186321!8164085!33186321
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suck abstract from ncbi


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pmid33186321      J+Hypertens 2021 ; 39 (4): 795-805
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  • Evaluating sources of bias in observational studies of angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker use during COVID-19: beyond confounding #MMPMID33186321
  • Cohen JB; D'Agostino McGowan L; Jensen ET; Rigdon J; South AM
  • J Hypertens 2021[Apr]; 39 (4): 795-805 PMID33186321show ga
  • Concerns over ACE inhibitor or ARB use to treat hypertension during COVID-19 remain unresolved. Although studies using more robust methodologies provided some clarity, sources of bias persist and it remains critical to quickly address this question. In this review, we discuss pernicious sources of bias using a causal model framework, including time-varying confounder, collider, information, and time-dependent bias, in the context of recently published studies. We discuss causal inference methodologies that can address these issues, including causal diagrams, time-to-event analyses, sensitivity analyses, and marginal structural modeling. We discuss effect modification and we propose a role for causal mediation analysis to estimate indirect effects via mediating factors, especially components of the renin--angiotensin system. Thorough knowledge of these sources of bias and the appropriate methodologies to address them is crucial when evaluating observational studies to inform patient management decisions regarding whether ACE inhibitors or ARBs are associated with greater risk from COVID-19.
  • |*COVID-19[MESH]
  • |Angiotensin Receptor Antagonists/pharmacology/*therapeutic use[MESH]
  • |Angiotensin-Converting Enzyme Inhibitors/pharmacology/*therapeutic use[MESH]
  • |Humans[MESH]
  • |Hypertension/drug therapy[MESH]
  • |Observational Studies as Topic[MESH]
  • |Renin-Angiotensin System/*drug effects[MESH]


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