Antihypertensives and their relation to mortality by SARS-CoV-2 infection.

The role of antihypertensives, especially Renin-Angiotensin-Aldosterone System inhibitors, is still debatable in COVID-19-related severity and outcome. Therefore, we search for a more global analysis of antihypertensive medication in relation to SAS-CoV-2 severity using prescription data worldwide. The association between the percentage use of different types of antihypertensive medications and mortality rates due to a SARS-CoV-2 infection during the first 3 weeks of the pandemic was analyzed using random effects linear regression models for 30 countries worldwide. Higher percentages of prescribed angiotensin receptor blockers (ARBs) (ß, 95% confidence interval [CI]; -0.02 [-0.04 to -0.0012]; p = .042) and calcium channel blockers (CCBs) (ß, 95% CI; -0.023 [-0.05 to -0.0028]; p = .0304) were associated with a lower first 3-week SARS-CoV-2-related death rate, whereas a higher percentage of prescribed angiotensin-converting enzyme inhibitors (ACEis) (ß, 95% CI; 0.03 [0.0061-0.05]; p = .0103) was associated with a higher first 3-week death rate, even when adjusted for age and metformin use. There was no association between the amount of prescribed beta-blockers (BBs) and diuretics (Diu) and the first 3-week death rate. When analyzing the combination of drugs that is used by at least 50% of antihypertensive users, within the different countries, countries with the lowest first 3-week death rates had at least an angiotensin receptor blocker as one of the most often prescribed antihypertensive medications (ARBs/CCBs: [ß, 95% CI; -0.02 [-0.03 to -0.004]; p = .009], ARBs/BBs: [ß, 95% CI; -0.03 [-0.05 to -0.006]; p = .01]). Finally, countries prescribing high-potency ARBs had lower first 3-week ARBs. In conclusion, ARBs and CCB seem to have a protective effect against death from SARS-CoV-2 infection.

Differences in baseline characteristics between type 2 diabetes mellitus patients treated with dipeptidyl peptidase-4 inhibitors in randomized controlled trials and those receiving the same treatment in real-world settings
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AIMS: The goal was to analyze differences between the baseline characteristics of type 2 diabetes mellitus (T2DM) patients treated with dipeptidyl peptidase-4 (DPP-4) inhibitors in three randomized clinical trials (RCTs) and those receiving the same treatment in a German real-world setting. MATERIALS AND METHODS: Details of the baseline characteristics of subjects with T2DM from three RCTs focusing on DPP-4 inhibitors were obtained. The present study also included T2DM patients receiving prescriptions for DPP-4 inhibitors who were followed between April 2007 and December 2016 in 1,246 general and diabetologist practices in Germany. Three different DPP-4 inhibitors were considered in the subsequent statistical analyses: sitagliptin, vildagliptin, and saxagliptin. The first outcome was the difference in baseline characteristics between patients in RCTs and those included in the real-world study for the three drugs. The second outcome was the proportion of real-world patients who met exclusion criteria and who could not have been included in RCTs. RESULTS: Patients being prescribed DPP-4 inhibitors were younger in RCTs than in the real-world setting. RCT participants receiving sitagliptin were also more likely to be men than the patients from the real-world study, whereas the opposite was observed for vildagliptin and saxagliptin. The share of real-world patients who met the exclusion criteria ranged from 20.7% for vildagliptin to 38.1% for sitagliptin. In the case of the proportion of people potentially not included in RCTs, figures ranged from 61.9% for sitagliptin to 79.3% for vildagliptin. CONCLUSION: Real-world studies should be included in the evaluation of new drugs in the future.
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