Initiation of antihypertensive drugs to patients with confirmed COVID‐19—A population‐based cohort study in Sweden

Mousa, Salar Issa; Nyberg, Fredrik; Hajiebrahimi, Mohammadhossein; Bertilsson, Rebecka; Nåtman, Jonatan; Santosa, Ailiana; Wettermark, Björn

doi:10.1111/bcpt.13766

Cited by 4 publications

(1 citation statement)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The associations of prehospital and in-hospital exposure and modifications in exposure (i.e., discontinuation, initiation) to cardiovascular therapies with the risk of in-hospital death were analyzed using multiple logistic regression models adjusted for age (quartiles) and the following confounders, all treated as binary variables: male sex, cardiovascular risk factor, history of cardiovascular disease, diabetes, renal disease, respiratory disease, liver disease, and malignancy. This set of confounders is the standard in similar papers dealing with the topic [ 17 – 19 ].…”

Section: Methodsmentioning

confidence: 99%

Cardiovascular therapy use, modification, and in-hospital death in patients with COVID-19: A cohort study

et al. 2022

View full text Add to dashboard Cite

Aims To assess the associations of exposure and modifications in exposure (i.e., discontinuation on admission, initiation during hospitalization) to eight common cardiovascular therapies with the risk of in-hospital death among inpatients with coronavirus disease 2019 (COVID-19). Methods In this observational study including 838 hospitalized unvaccinated adult patients with confirmed COVID-19, the use of cardiovascular therapies was assessed using logistic regression models adjusted for potential confounders. Results No cardiovascular therapy used before hospitalization was associated with an increased risk of in-hospital death. During hospitalization, the use of diuretics (aOR 2.59 [1.68–3.98]) was associated with an increase, and the use of agents acting on the renin-angiotensin system (aOR 0.39 [0.23–0.64]) and lipid-lowering agents (aOR 0.41 [0.24–0.68]) was associated with a reduction in the odds of in-hospital death. Exposure modifications associated with decreased survival were the discontinuation of an agent acting on the renin-angiotensin system (aOR 4.42 [2.08–9.37]), a β-blocker (aOR 5.44 [1.16–25.46]), a lipid-modifying agent (aOR 3.26 [1.42–7.50]) or an anticoagulant (aOR 5.85 [1.25–27.27]), as well as the initiation of a diuretic (aOR 5.19 [2.98–9.03]) or an antiarrhythmic (aOR 6.62 [2.07–21.15]). Exposure modification associated with improved survival was the initiation of an agent acting on the renin-angiotensin system (aOR 0.17 [0.03–0.82]). Conclusion In hospitalized and unvaccinated patients with COVID-19, there was no detrimental association of the prehospital use of any regular cardiovascular medication with in-hospital death, and these therapies should be continued as recommended.

show abstract

Section: Methodsmentioning

confidence: 99%

Cardiovascular therapy use, modification, and in-hospital death in patients with COVID-19: A cohort study

et al. 2022

View full text Add to dashboard Cite

show abstract

Initiation of antihypertensive drugs to patients with confirmed COVID‐19—A population‐based cohort study in Sweden

Mousa

Nyberg

Hajiebrahimi

et al. 2022

Basic Clin Pharma Tox

Self Cite

View full text Add to dashboard Cite

Purpose Hypertension is an important risk factor for severe outcomes in patients with COVID‐19, and antihypertensive drugs may have a protective effect. However, the pandemic may have negatively impacted health care services for chronic diseases. The aim of this study was to assess initiations of antihypertensive medicines in patients infected by COVID‐19. Methods A cohort study including all Swedish residents 20–80 years old with a COVID‐19 positive test compared with an unexposed group without COVID‐19 matched for age, sex, and index date (date of confirmed COVID‐19). Data were collected within SCIFI‐PEARL, a study including linked data on COVID tests, hospital diagnoses, dispensed prescriptions, and socioeconomic data from Swedish national registers. Initiations of different antihypertensive drugs were studied from March 2020 until October 2020. Associations between COVID‐19 and initiation of antihypertensives were assessed by a multivariable Cox proportional hazards model. Results A total of 224 582 patients (exposed and unexposed) were included. After adjusting for cardiovascular comorbidities and education level, ACEi was the most commonly initiated antihypertensive agent to patients with COVID‐19. Hazard ratio and 95% confidence interval for initiation of drug therapy was 1.83 [1.53–2.19] for ACEi, followed by beta‐blockers 1.74 [1.55–1.95], calcium channel blockers 1.61 [1.41–1.83], angiotensin receptor blockers 1.61 [1.40–1.86], and diuretics 1.53 [1.32–1.77]. Conclusion All antihypertensive medicines were initiated more frequently in COVID‐19 patients. This can either be associated with hypertension caused by the COVID‐19 infection, more frequent diagnosis of hypertension among people with COVID‐19 since they consult health care, or residual confounding factors not adjusted for in the study.

show abstract

Impact of the COVID-19 pandemic on initiation of antihypertensive drugs in Sweden: an interrupted time series study

Tomas,

Wettermark,

Nyberg

et al. 2024

BMJ Open

View full text Add to dashboard Cite

ObjectivesAntihypertensives reduce the risk of myocardial infarction and stroke. Restrictions during the COVID-19 pandemic limited access to healthcare, which may have had a negative impact on drug prescribing. This study aimed to assess the effect of the COVID-19 pandemic on the initiation of antihypertensive drugs.DesignInterrupted time series study using a segmented linear regression model.SettingSwedish population assessed through linked national healthcare registers.Participants720 300 new users of antihypertensives.InterventionMarch 2020, COVID-19 pandemic onset.Main outcomes measuresThe change in the initiation of antihypertensives expressed as monthly cumulative incidence, stratified by age and sex. Data on dispensed prescriptions of diuretics, beta-blockers, calcium channel blockers, ACE inhibitors (ACEi) and angiotensin receptor blockers were extracted from the Swedish Prescribed Drug Register, from March 2018 to November 2021. Initiation (new use) was defined as having no previous dispensations before March 2019. Monthly cumulative incidence in March 2019–November 2021 was calculated as the number of patients initiating each drug class in each month divided by the population.ResultsThe start of the pandemic was associated with an immediate drop in the initiation of any antihypertensive, but no sustained effects were observed, as the incidence continued to increase in the postinterruption period by +0.02% each month in both sexes. The immediate drop was statistically significant for ACEi in both sexes and all antihypertensive classes except diuretics in patients >65 years. А significant postintervention trend change was observed for initiation of diuretics (+0.013% overall), driven mainly by a significant increase in patients >65 years. Similar findings were also observed for diuretics in females (+0.02%) and ACEi (+0.03%) in patients >65 years.ConclusionsThe pandemic had an immediate negative short-term effect, but we found no major long-term negative influence of the COVID-19 pandemic on initiation of any type of antihypertensive drugs.

show abstract

Initiation of antihypertensive drugs to patients with confirmed COVID‐19—A population‐based cohort study in Sweden

Cited by 4 publications

References 49 publications

Cardiovascular therapy use, modification, and in-hospital death in patients with COVID-19: A cohort study

Cardiovascular therapy use, modification, and in-hospital death in patients with COVID-19: A cohort study

Initiation of antihypertensive drugs to patients with confirmed COVID‐19—A population‐based cohort study in Sweden

Impact of the COVID-19 pandemic on initiation of antihypertensive drugs in Sweden: an interrupted time series study

Contact Info

Product

Resources

About