{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T17:13:59Z","timestamp":1765041239242,"version":"build-2065373602"},"reference-count":50,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,1,6]],"date-time":"2022-01-06T00:00:00Z","timestamp":1641427200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background: It is uncertain whether exposure to renin\u2013angiotensin system (RAS) modifiers affects the severity of the new coronavirus disease 2019 (COVID-19) because most of the available studies are retrospective. Methods: We tested the prognostic value of exposure to RAS modifiers (either angiotensin-converting enzyme inhibitors [ACE-Is] or angiotensin receptor blockers [ARBs]) in a prospective study of hypertensive patients with COVID-19. We analyzed data from 566 patients (mean age 75 years, 54% males, 162 ACE-Is users, and 147 ARBs users) hospitalized in five Italian hospitals. The study used systematic prospective data collection according to a pre-specified protocol. All-cause mortality during hospitalization was the primary outcome. Results: Sixty-six patients died during hospitalization. Exposure to RAS modifiers was associated with a significant reduction in the risk of in-hospital mortality when compared to other BP-lowering strategies (odds ratio [OR]: 0.54, 95% confidence interval [CI]: 0.32 to 0.90, p = 0.019). Exposure to ACE-Is was not significantly associated with a reduced risk of in-hospital mortality when compared with patients not treated with RAS modifiers (OR: 0.66, 95% CI: 0.36 to 1.20, p = 0.172). Conversely, ARBs users showed a 59% lower risk of death (OR: 0.41, 95% CI: 0.20 to 0.84, p = 0.016) even after allowance for several prognostic markers, including age, oxygen saturation, occurrence of severe hypotension during hospitalization, and lymphocyte count (adjusted OR: 0.37, 95% CI: 0.17 to 0.80, p = 0.012). The discontinuation of RAS modifiers during hospitalization did not exert a significant effect (p = 0.515). Conclusions: This prospective study indicates that exposure to ARBs reduces mortality in hospitalized patients with COVID-19.<\/jats:p>","DOI":"10.3390\/jcdd9010015","type":"journal-article","created":{"date-parts":[[2022,1,7]],"date-time":"2022-01-07T01:15:26Z","timestamp":1641518126000},"page":"15","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Renin Angiotensin System Blockers and Risk of Mortality in Hypertensive Patients Hospitalized for COVID-19: An Italian Registry"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4925-7985","authenticated-orcid":false,"given":"Fabio","family":"Angeli","sequence":"first","affiliation":[{"name":"Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy"},{"name":"Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 21049 Tradate, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Verdecchia","sequence":"additional","affiliation":[{"name":"Fondazione Umbra Cuore e Ipertensione-ONLUS and Division of Cardiology, Hospital S. Maria Della Misericordia, 06100 Perugia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonella","family":"Balestrino","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudio","family":"Bruschi","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 27040 Montescano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piero","family":"Ceriana","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Chiovato","sequence":"additional","affiliation":[{"name":"Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy"},{"name":"Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6516-0959","authenticated-orcid":false,"given":"Laura Adelaide","family":"Dalla Vecchia","sequence":"additional","affiliation":[{"name":"Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 20019 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8601-423X","authenticated-orcid":false,"given":"Francesco","family":"Fanfulla","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1884-5058","authenticated-orcid":false,"given":"Maria Teresa","family":"La Rovere","sequence":"additional","affiliation":[{"name":"Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 27040 Montescano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3973-6931","authenticated-orcid":false,"given":"Francesca","family":"Perego","sequence":"additional","affiliation":[{"name":"Department of Subacute Therapy, Istituti Clinici Scientifici Maugeri IRCCS, 20019 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7387-505X","authenticated-orcid":false,"given":"Simonetta","family":"Scalvini","sequence":"additional","affiliation":[{"name":"Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Spanevello","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy"},{"name":"Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 21049 Tradate, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Egidio","family":"Traversi","sequence":"additional","affiliation":[{"name":"Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 27040 Montescano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dina","family":"Visca","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy"},{"name":"Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 21049 Tradate, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9389-7915","authenticated-orcid":false,"given":"Michele","family":"Vitacca","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1612-5329","authenticated-orcid":false,"given":"Tiziana","family":"Bachetti","sequence":"additional","affiliation":[{"name":"Scientific Direction, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"624052","DOI":"10.3389\/fphys.2021.624052","article-title":"Controversial Roles of the Renin Angiotensin System and Its Modulators during the COVID-19 Pandemic","volume":"12","author":"Gressens","year":"2021","journal-title":"Front. 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