Key result
Outpatient ACEi and ARB use linked to ~22% lower mortality vs other antihypertensives during viral illness.
Why the study?
Associations between outpatient ACE inhibitors and angiotensin receptor blockers and clinical outcomes in acute viral respiratory illness were unclear.
Do outpatient ACE inhibitors or ARBs reduce mortality and severe complications in hypertensive patients with acute viral respiratory illness compared to other hypertension medications?
Cohort (n=202,629)
Yes
Do outpatient ACE inhibitors or ARBs reduce mortality and severe complications in hypertensive patients with acute viral respiratory illness compared to other hypertension medications?
Answers are grounded in this paper and cite their sources.
Outpatient use of ACE inhibitors and ARBs is associated with lower mortality in hypertensive patients with acute viral respiratory illness, though falsification analyses suggest potential residual confounding.
OBJECTIVES: Evaluate associations between ACE inhibitors (ACEis) and angiotensin receptor blockers (ARBs) and clinical outcomes in acute viral respiratory illness (AVRI). DESIGN: Retrospective cohort analysis of claims data. SETTING: The USA; 2018-2019 influenza season. PARTICIPANTS: Main cohort: people with hypertension (HTN) taking an ACEi, ARB or other HTN medications, and experiencing AVRI. Falsification cohort: parallel cohort receiving elective knee or hip replacement. MAIN OUTCOME MEASURES: Main cohort: hospital admission, intensive care unit, acute respiratory distress (ARD), ARD syndrome and all-cause mortality. Falsification cohort: complications after surgery and all-cause mortality. RESULTS: The main cohort included 236 843 episodes of AVRI contributed by 202 629 unique individuals. Most episodes were in women (58.9%), 81.4% in people with Medicare Advantage and 40.3% in people aged 75+ years. Odds of mortality were lower in the ACEi (0.78 (0.74 to 0.83)) and ARB (0.64 (0.61 to 0.68)) cohorts compared with other HTN medications. On all other outcomes, people taking ARBs (but not ACEis) had a >10% reduction in odds of inpatient stays compared with other HTN medications.In the falsification analysis (N=103 353), both ACEis (0.89 (0.80 to 0.98)) and ARBs (0.82 (0.74 to 0.91)) were associated with decreased odds of complications compared with other HTN medications; ARBs (0.64 (0.47 to 0.87)) but not ACEis (0.79 (0.60 to 1.05)) were associated with lower odds of death compared with other HTN medications. CONCLUSIONS: Outpatient use of ARBs was associated with better outcomes with AVRI compared with other medications for HTN. ACEis were associated with reduced risk of death, but with minimal or no reduction in risk of other complications. A falsification analysis conducted to provide context on the possible causal implications of these findings did not provide a clear answer. Further analysis using observational data will benefit from additional approaches to assess causal relationships between these drugs and outcomes in AVRI.
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Jeffery et al. (2021) conducted a cohort in Acute viral respiratory illness and hypertension (n=202,629). ACE inhibitors and angiotensin receptor blockers vs. Other hypertension medications was evaluated on All-cause mortality (OR 0.78, 95% CI 0.74 to 0.83). Outpatient use of ACE inhibitors and ARBs was associated with lower odds of mortality during acute viral respiratory illness compared to other hypertension drugs.
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