Impact of Treatment with Renin–Angiotensin System Inhibitors on Clinical Outcomes in Hypertensive Patients Hospitalized with COVID-19

Abstract

Introduction: Concerns have been raised about the possible harmfulness of angiotensin-converter enzyme inhibitors (ACEi) and aldosterone receptor blockers (ARB) in patients with COVID-19. However, few data from a European population have been published, especially from hypertensive patients. Aim: To study the association between ACEi or ARB treatments and major adverse outcomes during hospitalisation in COVID-19 patients. Methods: We studied 545 consecutive hypertensive patientsadmitted to our institution due to COVID-19 with respiratory involvement. Weanalysed the incidence of combined event (death or mechanical ventilatorysupport) during hospitalisation, as well as the time to independent events. Results: 188 (34.5%) patients presentedthe combined endpoint. 182 (33.4%) patients died, and 21 (3.9%) neededmechanical ventilatory support. Patients with previous treatment with ACEi orARB presented similar incidence of the combined endpoint during hospitalisation(31.6% vs. 41.8%; p = 0.08), with a lower all-cause mortality rate (30.4% vs. 41.2%;p = 0.03) compared with those without prior treatment. Use of ACEi or ARB was not independentlyassociated with lower incidence of the combined endpoint [Adjusted OR 0.675 (95% CI 0.298–1.528; p = 0.146)], but it was associated with lower mortality [Adjusted OR 0.550 (95% CI 0.304–0.930; p = 0.047)]. Conclusions: The use of ACEi or ARB was associated with lessincidence of all-cause death during hospitalisation among hypertensive patientsadmitted with COVID-19 respiratory infection.