04-23-2020, 12:40 PM
ACE and ARB in hospitalized patients
04-23-2020, 12:47 PM
So that's one early outbreak social media fueled rumor debunked. Hydroxychloroquine another. NSAIDs probably next.
04-23-2020, 01:13 PM
POsted this study separately noting the high mortality among mechanically ventilated patients. But this study also looked at ACE/ARB's
https://jamanetwork.com/journals/jama/fu...le/2765184
BC
https://jamanetwork.com/journals/jama/fu...le/2765184
Quote:Angiotensin-Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Use
Home medication reconciliation information was available for 2411 (92%) of the 2634 patients who were discharged or who died by the study end. Of these 2411 patients, 189 (7.8%) were taking an angiotensin-converting enzyme inhibitor (ACEi) at home and 267 (11.1%) were taking an angiotensin II receptor blocker (ARB) at home. The median number of total home medications was 3 (IQR, 0-7). Outcomes for subgroups of patients with hypertension by use of ACEi or ARB home medication are shown in eTable 2 in the Supplement. Numbers provided for total patients taking ACEi or ARB therapy in eTable 2 in the Supplement are provided only for patients who also had a diagnosis of hypertension.
Of the patients taking an ACEi at home, 91 (48.1%) continued taking an ACEi while in the hospital and the remainder discontinued this type of medication during their hospital visit. Of the patients taking an ARB at home, 136 (50.1%) continued taking an ARB while in the hospital and the remainder discontinued taking this type of medication during their hospital visit. Of patients who were not prescribed an ACEi or ARB at home, 49 started treatment with an ACEi and 58 started treatment with an ARB during their hospitalization. Mortality rates for patients with hypertension not taking an ACEi or ARB, taking an ACEi, and taking an ARB were 26.7%, 32.7%, and 30.6%, respectively.
...
[from the Discussion]
ACEi and ARB medications can significantly increase mRNA expression of cardiac angiotensin-converting enzyme 2 (ACE2),11 leading to speculation about the possible adverse, protective, or biphasic effects of treatment with these medications.12 This is an important concern because these medications are the most prevalent antihypertensive medications among all drug classes.13 However, this case series design cannot address the complexity of this question, and the results are unadjusted for known confounders, including age, sex, race, ethnicity, socioeconomic status indicators, and comorbidities such as diabetes, chronic kidney disease, and heart failure.
BC
POsted this study separately noting the high mortality among mechanically ventilated patients. But this study also looked at ACE/ARB's
https://jamanetwork.com/journals/jama/fu...le/2765184
BC
https://jamanetwork.com/journals/jama/fu...le/2765184
Quote:Angiotensin-Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Use
Home medication reconciliation information was available for 2411 (92%) of the 2634 patients who were discharged or who died by the study end. Of these 2411 patients, 189 (7.8%) were taking an angiotensin-converting enzyme inhibitor (ACEi) at home and 267 (11.1%) were taking an angiotensin II receptor blocker (ARB) at home. The median number of total home medications was 3 (IQR, 0-7). Outcomes for subgroups of patients with hypertension by use of ACEi or ARB home medication are shown in eTable 2 in the Supplement. Numbers provided for total patients taking ACEi or ARB therapy in eTable 2 in the Supplement are provided only for patients who also had a diagnosis of hypertension.
Of the patients taking an ACEi at home, 91 (48.1%) continued taking an ACEi while in the hospital and the remainder discontinued this type of medication during their hospital visit. Of the patients taking an ARB at home, 136 (50.1%) continued taking an ARB while in the hospital and the remainder discontinued taking this type of medication during their hospital visit. Of patients who were not prescribed an ACEi or ARB at home, 49 started treatment with an ACEi and 58 started treatment with an ARB during their hospitalization. Mortality rates for patients with hypertension not taking an ACEi or ARB, taking an ACEi, and taking an ARB were 26.7%, 32.7%, and 30.6%, respectively.
...
[from the Discussion]
ACEi and ARB medications can significantly increase mRNA expression of cardiac angiotensin-converting enzyme 2 (ACE2),11 leading to speculation about the possible adverse, protective, or biphasic effects of treatment with these medications.12 This is an important concern because these medications are the most prevalent antihypertensive medications among all drug classes.13 However, this case series design cannot address the complexity of this question, and the results are unadjusted for known confounders, including age, sex, race, ethnicity, socioeconomic status indicators, and comorbidities such as diabetes, chronic kidney disease, and heart failure.
BC
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