Chronic use of Renin‐Angiotensin‐Aldosterone‐System blockers and mortality in COVID‐19: a multicenter prospective cohort and literature review - Institut Pierre Louis d'Epidémiologie et de Santé Publique Accéder directement au contenu
Article Dans Une Revue Fundamental & Clinical Pharmacology Année : 2021

Chronic use of Renin‐Angiotensin‐Aldosterone‐System blockers and mortality in COVID‐19: a multicenter prospective cohort and literature review

1 CIC 1425 - Centre d'investigation Clinique [CHU Bichat] - Épidémiologie clinique
2 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
3 DEBRC - Département d'Epidemiologie, Biostatistique et Recherche Clinique
4 URC PNVS - Unité de recherche clinique Paris Nord Val de Seine [Paris]
5 BRM - ARN régulateurs bactériens et médecine
6 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
7 VCPME - Vulnérabilité cardiovasculaire, pathologie métabolique et endocrinienne
8 CHU de la Martinique [Fort de France]
9 CIC - Antilles Guyane - Centre d'investigation clinique Antilles-Guyane
10 PARCC (UMR_S 970/ U970) - Paris-Centre de Recherche Cardiovasculaire
11 CIC 1418 - CIC - HEGP
12 DMU CARTE - CArdiovasculaire Rénal Transplantation nEurovasculaire [Paris]
13 Cardiovascular & Renal Clinical Trialists - CRCT - French-Clinical Research Infrastructure Network - F-CRIN [Paris]
14 Services de Maladies Infectieuses et Tropicales [CHU Bichat]
15 Hôpital JeanMinjoz
16 LCE - Laboratoire Chrono-environnement (UMR 6249)
17 Service d'Anesthésie-Réanimation [CHU HEGP]
18 IThEM - U1140 - Innovations thérapeutiques en hémostase = Innovative Therapies in Haemostasis
19 HEGP - Hôpital Européen Georges Pompidou [APHP]
20 UGSF - Unité de Glycobiologie Structurale et Fonctionnelle - UMR 8576
21 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
22 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
23 APEMAC - Adaptation, mesure et évaluation en santé. Approches interdisciplinaires
24 Service des Maladies Infectieuses et Tropicales [CHRU Nancy]
25 Département d'infectiologie (CHU de Dijon)
26 IAME (UMR_S_1137 / U1137) - Infection, Anti-microbiens, Modélisation, Evolution
27 Service de Médecine Hospitalière - CHU Beziers
28 Service des maladies infectieuses et tropicales [Rouen]
29 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
30 INI-CRCT - Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy]
31 CIC-P - Centre d'investigation clinique plurithématique Pierre Drouin [Nancy]
32 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
33 CRI (UMR_S_1149 / ERL_8252 / U1149) - Centre de recherche sur l'Inflammation
34 AGIR - Agents infectieux, résistance et chimiothérapie - UR UPJV 4294
35 CHU Amiens-Picardie
36 French COVID cohort study group
Eric Oziol
  • Fonction : Auteur

Résumé

Aims: The role of renin-angiotensin-aldosterone system (RAAS) blockers on the course of coronavirus disease 2019 (COVID-19) is debated. We assessed the association between chronic use of RAAS blockers and mortality among inpatients with COVID-19, and explored reasons for discrepancies in the literature.Methods and results: We included adult hypertensive patients from a prospective nationwide cohort of 3512 inpatients with COVID-19 up to June 30, 2020. Cox proportional hazard models with various adjustment or propensity weighting methods were used to estimate the Hazard Ratios (HR) of 30-day mortality for chronic users versus non-users of RAAS blockers. We analyzed data of 1160 hypertensive patients; 719 (62%) were male, 777 (67%) were older than 65 years. The main comorbidities were diabetes (n=416, 36%), chronic cardiac disease (n=401, 35%) and obesity (n=340, 29%); 705 (61%) received oxygen therapy. We recorded 135 (11.6%) deaths within 30 days of diagnosis. We found no association between chronic use of RAAS blockers and mortality (unadjusted HR=1.13, 95% CI [0.8-1.6]; propensity inverse probability treatment weighted HR=1.09 [0.86-1.39]; propensity standardized mortality ratio weighted HR=1.08 [0.79-1.47]). Our comprehensive review of previous studies highlighted that significant associations were mostly found in unrestricted populations with inappropriate adjustment, or with biased in-hospital exposure measurement.Conclusion: Our results do not support previous concerns regarding these drugs, nor a potential protective effect as reported in previous poorly designed studies and metanalyses. RAAS blockers should not be discontinued during the pandemic, while in-hospital management of these drugs will be clarified by randomized trials. NCT04262921.
Fichier principal
Vignette du fichier
Gault et al-2021-Chronic use of Renin-Angiotensin-Aldosterone-System blockers and mortality in.pdf (1.39 Mo) Télécharger le fichier
Origine : Fichiers produits par l'(les) auteur(s)

Dates et versions

inserm-03205276 , version 1 (22-04-2021)
inserm-03205276 , version 2 (23-04-2021)

Identifiants

Citer

Nathalie Gault, Marina Esposito‐farese, Matthieu Revest, Jocelyn Inamo, André Cabie, et al.. Chronic use of Renin‐Angiotensin‐Aldosterone‐System blockers and mortality in COVID‐19: a multicenter prospective cohort and literature review. Fundamental & Clinical Pharmacology, 2021, 35 (6), pp.1141-1158. ⟨10.1111/fcp.12683⟩. ⟨inserm-03205276v2⟩
260 Consultations
386 Téléchargements

Altmetric

Partager

Gmail Facebook X LinkedIn More