Evidence map›Paper›PMID 34599472›Full record

Observational studyJournal of general internal medicine2021

Risk of Covid-19-Related Hospitalization and More Severe Outcomes in Medicare Beneficiaries Treated with Renin-Angiotensin-Aldosterone System Inhibitors for Hypertension.

David J Graham, Hector S Izurieta, Stella G Muthuri, Di Zhang, Alexander T Sandhu, Yun Lu, Yueqin Zhao, Yuhui Feng, Efe Eworuke, Hai Lyu and 7 more

Open access · bronzeAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Journal of general internal medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
0.3field-weighted citation impact, top 42% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it, 4 citations in OpenAlex.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors at 4 institutions in 1 country.

David J GrahamOffice of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, 10903 New Hampshire Ave, Building 22, Room 4314, Silver Spring, MD, 20993, USA. david.graham1@fda.hhs.gov.ORCID 0000-0002-7469-4047
Hector S IzurietaOffice of Vaccines Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.
Stella G MuthuriAcumen LLC, Burlingame, CA, USA.
Di ZhangOffice of Biostatistics, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.
Alexander T SandhuAcumen LLC, Burlingame, CA, USA.
Yun LuOffice of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.
Yueqin ZhaoOffice of Biostatistics, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.
Yuhui FengAcumen LLC, Burlingame, CA, USA.
Efe EworukeOffice of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, 10903 New Hampshire Ave, Building 22, Room 4314, Silver Spring, MD, 20993, USA.
Hai LyuAcumen LLC, Burlingame, CA, USA.
Charu GandotraOffice of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.
Elizabeth R SmithAcumen LLC, Burlingame, CA, USA.
Armen AvagyanAcumen LLC, Burlingame, CA, USA.
Michael WerneckeAcumen LLC, Burlingame, CA, USA.
Jeffrey A KelmanCenters for Medicare & Medicaid Services, Washington, DC, USA.
Richard A ForsheeOffice of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.
Thomas E MaCurdyAcumen LLC, Burlingame, CA, USA.
Acumen (United States) · USUnited States Food and Drug Administration · USCenter for Biologics Evaluation and Research · USCenters for Medicare and Medicaid Services · US

Funding

U.S. Food and Drug Administration Inter-agency agreement
6 · The paper itself

Abstract

backgroundThere are theoretical concerns that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) could increase the risk of severe Covid-19.

objectiveTo determine if ACEIs and ARBs are associated with an increased risk of Covid-19 hospitalization overall, or hospitalization involving intensive care unit (ICU) admission, invasive mechanical ventilation, or death.

designObservational case-control study.

participantsMedicare beneficiaries aged ≥ 66 years with hypertension, treated with ACEIs, ARBs, calcium channel blockers (CCBs), or thiazide diuretics. MAIN MEASURES: Adjusted odds ratios (OR) and 95% confidence intervals (CI) for the outcomes of Covid-19 hospitalization, or hospitalization involving ICU admission, invasive mechanical ventilation, or death.

resultsA total of 35,300 cases of hospitalized Covid-19 were matched to 228,228 controls on calendar date and neighborhood of residence. The median age of cases was 79 years, 57.4% were female, and the median duration of hospitalization was 8 days (interquartile range 5-12). ACEIs and ARBs were associated with a slight reduction in Covid-19 hospitalization risk compared with treatment with other first-line antihypertensives (OR for ACEIs 0.95, 95% CI 0.92-0.98; OR for ARBs 0.94, 95% CI 0.90-0.97). Similar results were obtained for hospitalizations involving ICU admission, invasive mechanical ventilation, or death. There were no meaningful differences in risk for ACEIs compared with ARBs. In an analysis restricted to monotherapy with a first-line agent, CCBs were associated with a small increased risk of Covid-19 hospitalization compared with ACEIs (OR 1.09, 95% CI 1.04-1.14), ARBs (OR 1.10, 95% CI 1.05-1.15), or thiazide diuretics (OR 1.11, 95% CI 1.03-1.19).

conclusionsACEIs and ARBs were not associated with an increased risk of Covid-19 hospitalization or with hospitalization involving ICU admission, invasive mechanical ventilation, or death. The finding of a small increased risk of Covid-19 hospitalization with CCBs was unexpected and could be due to residual confounding.

Indexed as

COVID-19HypertensionAgedAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsCase-Control StudiesFemaleHospitalizationHumansMedicareRenin-Angiotensin SystemSARS-CoV-2United StatesAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor Antagonistsangiotensin-converting enzyme inhibitorsangiotensin receptor blockersCovid-19intensive caremechanical ventilation

Identifiers

PMID34599472
PMCPMC8486159
OpenAlexW3202461304

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.