JAMA:高血压患者不应因新冠肺炎因素停止血管紧张素转换酶抑制剂或血管紧张素II受体阻滞剂治疗

2021-01-20 MedSci原创 MedSci原创

对于正在服用血管紧张素转换酶抑制剂(ACEIs)或血管紧张素II受体阻滞剂(ARBs)的轻中度新冠肺炎患者,不支持上述患者因新冠肺炎因素停止降压药物治疗

血管紧张素转化酶2(ACE2)是肾素-血管紧张素-醛固酮系统(RAAS)的关键靶点,同时也是严重急性呼吸综合征冠状病毒2(SARS-cov-2)侵入细胞的"门户"。近日研究人员考察了在患有高血压的2019冠状病毒病(COVID-19)患者中,停止或继续接受血管紧张素转换酶抑制剂(ACEIs)或血管紧张素II受体阻滞剂(ARBs)对患者30天新冠肺炎预后的影响。
 
659名轻中度COVID-19住院患者参与,患者在住院前服用ACEIs或ARBs,其中334人停止了ACEIs或ARBs治疗,325人仍持续ACEIs或ARBs治疗。研究的主要终点为30天内存活且出院的天数。次要终点包括死亡、心血管死亡和COVID-19进展。
 
患者平均年龄为55.1岁,70岁及以上患者占14.7%,女性占40.4%,所有患者均完成试验。从症状出现到入院的平均时间为6天。在基线时,血氧饱和度低于94%的患者比例为27.2%,57.1%的患者入院时病情评估为轻度,42.9%为中度的。停止ACEIs或ARBs治疗组患者的存活-出院天数与持续治疗组无显著差异(21.9 vs 22.9天,OR=0.95)。组间患者死亡(停药组2.7% vs 继续治疗组2.8%;OR:0.97)、心血管死亡(0.6% vs 0.3%;OR:1.95)或COVID-19进展(38.3% vs 32.3%;OR:1.30)风险相当。最常见的不良事件是呼吸衰竭、休克、急性心肌梗死、新发或心衰恶化及急性肾衰竭。
 
对于正在服用血管紧张素转换酶抑制剂(ACEIs)或血管紧张素II受体阻滞剂(ARBs)的轻中度新冠肺炎患者,不支持上述患者因新冠肺炎因素停止降压药物治疗
 
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content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Wed Jan 20 22:09:06 CST 2021, time=2021-01-20, status=1, ipAttribution=)]
    2021-06-15 jklm09
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content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Wed Jan 20 22:09:06 CST 2021, time=2021-01-20, status=1, ipAttribution=)]
    2021-06-05 zhyy88
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href='/topic/show?id=fb0389e4373' target=_blank style='color:#2F92EE;'>#血管紧张素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89743, encryptionId=fb0389e4373, topicName=血管紧张素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5ce517702394, createdName=xiongliangxl, createdTime=Fri Jan 22 10:09:06 CST 2021, time=2021-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1029014, encodeId=4705102901405, content=新冠肺炎,疫情何时才能消失, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=公卫新人, createdTime=Wed Jan 20 22:09:06 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036406, encodeId=eb07103640605, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Wed Jan 20 22:09:06 CST 2021, time=2021-01-20, status=1, ipAttribution=)]
    2021-01-22 jeanqiuqiu
  5. 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content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Wed Jan 20 22:09:06 CST 2021, time=2021-01-20, status=1, ipAttribution=)]
  6. 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content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Wed Jan 20 22:09:06 CST 2021, time=2021-01-20, status=1, ipAttribution=)]
  7. 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  8. 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content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Wed Jan 20 22:09:06 CST 2021, time=2021-01-20, status=1, ipAttribution=)]
  9. 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content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Wed Jan 20 22:09:06 CST 2021, time=2021-01-20, status=1, ipAttribution=)]
    2021-01-20 公卫新人

    新冠肺炎,疫情何时才能消失

    0

  10. 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    2021-01-20 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

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高血压是一个极其复杂的疾病,比如其危险因素包括肥胖、高钠摄入、老年、高血压家族史、吸烟、应激、静态生活方式等,其合并疾病包括糖尿病、阻塞性睡眠呼吸暂停、内分泌疾病、肾脏疾病等。

为何A+C成为主导?从高血压始动机制和间接机制的动态演变谈起

高血压发病存在多因素、多机制,任何高血压患者均非仅存在单一高血压机制,必然或多或少存在上述提到的四种高血压发病机制,将来的发展趋势都应该是多种成分、多种机制的药物联合应用。

Nature Biotechnology:高血压延迟病毒清除并加剧COVID-19患者的气道炎症

合并高血压的COVID-19患者更有可能发生严重并发症,这也使他们面临更大的死亡风险。科学家现在发现,高血压患者的免疫细胞已经被预先激活,而且这种预先激活在COVID-19下大大增强。 

Eur Heart J:脂蛋白(a)、LDL-C和高血压是FH患者需要主动脉瓣置换的预测因素

家族性高胆固醇血症(FH)和脂蛋白(a)[Lp(a)]升高是与过早型动脉粥样硬化性心血管疾病(ASCVD)相关的遗传性疾病。主动脉瓣狭窄(AVS)是最常见的瓣膜性心脏病,低密度脂蛋白胆固醇(LDL-C