美国纽约大学格罗斯曼医学院Harmony R. Reynolds团队取得一项新进展。他们研究了肾素-血管紧张素-醛固酮系统抑制剂和Covid-19风险之间的相关性。该研究于2020年5月1日发表在《新英格兰医学杂志》上。

由于新冠病毒受体是血管紧张素转换酶2（ACE2），因此暴露于冠状病毒病2019（Covid-19）的患者使用肾素-血管紧张素-醛固酮系统相关药物的风险可能会增加。

研究组评估了先前使用过血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂、β受体阻滞剂、钙通道阻滞剂或噻嗪类利尿剂治疗的患者与Covid-19检测结果阳性或阴性以及阳性重症（定义为重症监护、机械通气或死亡）之间的相关性。

在接受Covid-19检测的12594例患者中，共有5894例（46.8%）为阳性，其中1002名（17.0％）为重症。4357名（34.6％）患者有高血压病史，其中2573名（59.1％）呈阳性，阳性患者中有634名（24.6％）为重症。所有药物类别与检测阳性率增加均无关联。在检测为阳性的患者中，所有药物均与重症风险增加亦不相关。

总之，服用五种常见降压药物的患者，Covid-19阳性率以及重症风险均未发生实质性的增加。

附：英文原文

Title: Renin–Angiotensin–Aldosterone System Inhibitors and Risk of Covid-19

Author: Harmony R. Reynolds, M.D.,, Samrachana Adhikari, Ph.D.,, Claudia Pulgarin, M.A., M.S.,, Andrea B. Troxel, Sc.D.,, Eduardo Iturrate, M.D., M.S.W.,, Stephen B. Johnson, Ph.D.,, Anas Hausvater, M.D.,, Jonathan D. Newman, M.D., M.P.H.,, Jeffrey S. Berger, M.D.,, Sripal Bangalore, M.D.,, Stuart D. Katz, M.D.,, Glenn I. Fishman, M.D.,, Dennis Kunichoff, M.P.H.,, Yu Chen, M.P.H., Ph.D.,, Gbenga Ogedegbe, M.D., M.P.H.,, and Judith S. Hochman, M.D.

Issue&Volume: 2020-05-01

Abstract: BACKGROUND

There is concern about the potential of an increased risk related to medications that act on the renin–angiotensin–aldosterone system in patients exposed to coronavirus disease 2019 (Covid-19), because the viral receptor is angiotensin-converting enzyme 2 (ACE2).

METHODS

We assessed the relation between previous treatment with ACE inhibitors, angiotensin-receptor blockers, beta-blockers, calcium-channel blockers, or thiazide diuretics and the likelihood of a positive or negative result on Covid-19 testing as well as the likelihood of severe illness (defined as intensive care, mechanical ventilation, or death) among patients who tested positive. Using Bayesian methods, we compared outcomes in patients who had been treated with these medications and in untreated patients, overall and in those with hypertension, after propensity-score matching for receipt of each medication class. A difference of at least 10 percentage points was prespecified as a substantial difference.

RESULTS

Among 12,594 patients who were tested for Covid-19, a total of 5894 (46.8%) were positive; 1002 of these patients (17.0%) had severe illness. A history of hypertension was present in 4357 patients (34.6%), among whom 2573 (59.1%) had a positive test; 634 of these patients (24.6%) had severe illness. There was no association between any single medication class and an increased likelihood of a positive test. None of the medications examined was associated with a substantial increase in the risk of severe illness among patients who tested positive.

CONCLUSIONS

We found no substantial increase in the likelihood of a positive test for Covid-19 or in the risk of severe Covid-19 among patients who tested positive in association with five common classes of antihypertensive medications.

DOI: NJ202005013822503

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2008975