Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Racial discrimination and well -being among African American university students.

For most college students, academic achievement is not only a goal but it is likely their primary purpose for attending the university. While any form of stress may be problematic, some suggest that in order for a stressor to be harmful, it would need to be an important factor in an individual's life (Steele, 1998). Because of its significance to the lives of African American college students, experiencing discrimination that is specifically targeted toward African Americans' competence may be harmful to their personal well-being. Specifically, this study attempted to understand the relationship between competence-focused daily hassles discrimination and students' global self-esteem and academic performance. This survey study assessed 268 African American college students' experiences with daily racist hassles (Harrell, 1998) that target their intelligence and academic competence. Discrimination was measured by asking how frequently students' experienced these events, and how bothered they were by the experience. Hierarchical regressions were conducted predicting global self-esteem and students' academic performance (as measured by GPA's) from students' experiences with competence related racial discrimination. Racial Centrality and students' experiences with other African Americans were entered as moderating variables. The overall findings in this study suggest that African Americans students show a great deal resilience to the possible negative consequences of experiencing racial discrimination. While the vast majority of students had experienced racial discrimination, there were very few relationships between experiencing more frequent or more bothersome discrimination and the well being outcomes of self-esteem and academic performance. In fact, where there was a direct relationship, it was in the direction of being more resilient, rather than more harmed. Further, the relationships that did exist differed for males and females. For instance, women had higher GPA's when they were more bothered by discrimination, yet no relationship existed for men. These findings indicate a need to problematize the ways that racial discrimination relate specifically to different types of well being outcomes, among different students. Further, the findings suggest that African American women and men may respond to racial discrimination in different manners. Further research is needed better understand these phenomena.Ph.D.Black studiesClinical psychologyEthnic studiesPersonality psychologyPsychologySocial SciencesUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/129333/2/3042059.pd