Các chất ức chế hệ thống renin-angiotensin và sự nhạy cảm với COVID-19 ở bệnh nhân tăng huyết áp: Một nghiên cứu nhóm đối tượng khớp theo điểm thiên lệch trong chăm sóc sức khỏe ban đầu

BMC Infectious Diseases - Tập 21 Số 1 - 2021
Shamil Haroon1, Anuradhaa Subramanian1, Jennifer Cooper1, Astha Anand1, Krishna Gokhale1, Nathan Byne2, Samir Dhalla3, Dionisio Acosta‐Mena2, Thomas Taverner1, Kelvin Okoth1, Jingya Wang1, Joht Singh Chandan1, Christopher Sainsbury4, Dawit T Zemedikun1, G. Neil Thomas1, Dhruv Parekh5, Tom Marshall1, Elizabeth Sapey5, Nicola J Adderley1, Krishnarajah Nirantharakumar6
1Institute of Applied Health Research, University of Birmingham, Birmingham, UK
2Cegedim Health Data, Cegedim Rx, London, UK
3The Health Improvement Network (THIN), London, UK
4Department of Diabetes, Gartnavel General Hospital, NHS Greater Glasgow and Clyde, Glasglow, UK
5Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
6Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

Tóm tắt

Tóm tắt Giới thiệu Các chất ức chế hệ thống renin-angiotensin (RAS) được cho là có ảnh hưởng đến độ nhạy cảm với virus corona gây hội chứng hô hấp cấp tính nghiêm trọng 2 (SARS-CoV-2). Nghiên cứu này đã điều tra xem có mối liên hệ nào giữa việc kê đơn các chất này và tỷ lệ mắc COVID-19 cũng như tỷ lệ tử vong do mọi nguyên nhân hay không. Phương pháp Chúng tôi đã thực hiện một nghiên cứu nhóm đối tượng khớp theo điểm thiên lệch so sánh tỷ lệ mắc COVID-19 giữa các bệnh nhân tăng huyết áp được kê đơn thuốc ức chế men chuyển angiotensin I (ACE) hoặc thuốc chẹn thụ thể angiotensin II loại 1 (ARBs) với những người được điều trị bằng thuốc chặn kênh canxi (CCBs) trong một cơ sở dữ liệu chăm sóc sức khỏe ban đầu lớn dựa trên Vương quốc Anh (Mạng cải thiện sức khỏe). Chúng tôi ước tính tỷ lệ mắc thô cho các trường hợp COVID-19 đã xác nhận/nghi ngờ trong mỗi nhóm sử dụng thuốc. Chúng tôi đã sử dụng mô hình nguy cơ tỷ lệ Cox để sản xuất tỷ lệ rủi ro điều chỉnh cho COVID-19. Chúng tôi đã đánh giá tỷ lệ tử vong do mọi nguyên nhân như là một kết quả thứ cấp. Kết quả Tỷ lệ mắc COVID-19 ở những người dùng thuốc ức chế ACE và CCBs lần lượt là 9.3 trên 1000 người-năm (83 trong số 18,895 người dùng [0.44%]) và 9.5 trên 1000 người-năm (85 trong số 18,895 [0.45%]). Tỷ lệ rủi ro điều chỉnh là 0.92 (95% CI 0.68 đến 1.26). Tỷ lệ mắc ở nhóm người dùng ARBs là 15.8 trên 1000 người-năm (79 trong số 10,623 người dùng [0.74%]). Tỷ lệ rủi ro điều chỉnh là 1.38 (95% CI 0.98 đến 1.95). Không có mối liên hệ đáng kể nào giữa việc sử dụng các chất ức chế RAS và tỷ lệ tử vong do mọi nguyên nhân. Kết luận Sử dụng thuốc ức chế ACE không liên quan đến nguy cơ mắc COVID-19 trong khi việc sử dụng ARBs có liên quan đến một sự gia tăng không có ý nghĩa thống kê so với việc sử dụng CCBs. Tuy nhiên, không quan sát thấy mối liên hệ đáng kể nào giữa việc kê đơn thuốc ức chế ACE hoặc ARBs và tỷ lệ tử vong do mọi nguyên nhân.

Từ khóa

#hệ thống renin-angiotensin #COVID-19 #bệnh nhân tăng huyết áp #nghiên cứu nhóm đối tượng khớp theo điểm thiên lệch

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BMC Infectious Diseases

Tập 21 Số 1

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