Impact of angiotensin receptor blockers use on in-hospital mortality in community acquired pneumonia patients with hypertension

Introduction: This study aims to explore the association of angiotensin receptor blockers (ARBs) use with in-hospital mortality among Chinese patients with hypertension hospitalized with community acquired pneumonia (CAP). Methods: This study was conducted from January 2014 to January 2017, and data from patients with hypertension hospitalized with CAP were analyzed retrospectively. Multivariable logistic regression and propensity score matching (PSM) were used to investigate any association. Results: 1510 patients were included in this study. The crude in-hospital mortality was significantly lower in patients with ARBs use (4.2% vs. 12.5%, P < 0.001). In the extended multivariable logistic models, the odds ratios (ORs) of ARBs use were consistently significant in all six models (ORs range 0.27–0.48, P < 0.05 for all). After subgroup analysis, ARBs use remained a potentially protective factor against in-hospital mortality, and no interaction was detected. After propensity score matching, the in-hospital mortality remained significantly lower in the ARBs use group (4.2% vs. 10.9%, P = 0.002). In the univariate analysis, using ARBs was associated with in-hospital mortality (PSM OR, 0.36; 95%CI, 0.19-0.68; P = 0.002). Additionally, compared with the control group, ARBs use did not significantly increase the risk of acute kidney injury (AKI) (12.4% vs 10.9%, P = 0.628), renal replacement therapy (RRT) (0.6% vs. 0.3%, P = 1.000) and hyperkalemia (1.8% vs 2.1%, P = 1.000). Conclusion: Although residual confounding cannot be excluded, the use of ARBs was associated with lower in-hospital mortality in Chinese patients with hypertension hospitalized with CAP