Associação entre o Antagonismo do Sistema Renina-Angiotensina-Aldosterona e a Mortalidade Relacionada à COVID-19 em Pacientes com Hipertensão Relacionada ao Sobrepeso/Obesidade: um Estudo Retrospectivo de Coorte

Abstract

Abstract Background Angiotensin receptor blockers (ARB) and angiotensin-converting enzyme inhibitors (ACEI) increase the expression of ACE2, which is a receptor for entry of SARS-CoV-2 into cells. Though evidence suggests that ARB/ACEI are safe among the general population with COVID-19, their safety in patients with overweight/obesity-related hypertension deserves further evaluation. Objective We assessed the association between ARB/ACEI use and COVID-19 severity in patients with overweight/obesity-related hypertension. Methods This study included 439 adult patients with overweight/obesity (body mass index ≥ 25 kg/m2) and hypertension, diagnosed with COVID-19 and admitted to University of Iowa Hospitals and Clinic from March 1 to December 7, 2020. Mortality and severity of COVID-19 were evaluated based on length of stay in hospital, intensive care unit admission, use of supplemental oxygen, mechanical ventilation, and vasopressors. Multivariable logistic regression was used to examine the associations of ARB/ACEI use with mortality and other markers of COVID-19 severity, with a two-sided alpha set at 0.05. Results Exposure to ARB (n = 91) and ACEI (n = 149) before hospitalization was significantly associated with lower mortality (odds ratio [OR] = 0.362, 95% confidence interval [CI] 0.149 to 0.880, p = 0.025) and a shorter length of stay (95% CI −0.217 to −0.025, p = 0.015). Additionally, patients using ARB/ACEI showed a non-significant trend toward lower intensive care unit admission (OR = 0.727, 95% CI 0.485 to 1.090, p = 0.123), use of supplemental oxygen (OR = 0.929, 95% CI 0.608 to 1.421, p = 0.734), mechanical ventilation (OR = 0.728, 95% CI 0.457 to 1.161, p = 0.182), and vasopressors (OR = 0.677, 95% CI 0.430 to 1.067, p = 0.093). Conclusion Results suggest that hospitalized patients with COVID-19 and overweight/obesity-related hypertension who were prescribed ARB/ACEI before admission to the hospital exhibit lower mortality and less severe COVID-19 than those who were not taking ARB/ACEI. The results also suggest that exposure to ARB/ACEI may protect patients with overweight/obesity-related hypertension from severe COVID-19 and death. (ARB angiotensinconverting angiotensin converting (ACEI ACE2 ACE SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- cells ARBACEI COVID19, COVID19 COVID 19, 19 overweight/obesityrelated overweightobesityrelated related overweight obesity evaluation COVID-1 43 overweightobesity body kg/m2 kgm2 kgm kg m2 m 7 2020 twosided two sided 005 0 05 0.05 n 91 149 odds OR [OR 0362 362 0.362 95 [CI 0149 0.14 0880 880 0.880 0.025 0025 025 (95 0217 217 −0.21 −0.025 0.015. 0015 0.015 . 015 0.015) Additionally nonsignificant non significant 0727 727 0.727 0485 485 0.48 1090 090 1.090 0.123, 0123 0.123 , 123 0.123) 0929 929 0.929 0608 608 0.60 1421 421 1.421 0.734, 0734 0.734 734 0.734) 0728 728 0.728 0457 457 0.45 1161 161 1.161 0.182, 0182 0.182 182 0.182) 0677 677 0.677 0430 430 0.43 1067 067 1.067 0.093. 0093 0.093 093 0.093) death SARS-CoV COVID1 obesityrelated COVID- 4 kg/m 202 00 0.0 9 14 036 36 0.36 014 0.1 088 88 0.88 0.02 002 02 (9 021 21 −0.2 −0.02 001 0.01 01 072 72 0.72 048 48 0.4 109 09 1.09 012 0.12 12 092 92 0.92 060 60 0.6 142 42 1.42 073 0.73 73 045 45 116 16 1.16 018 0.18 18 67 0.67 043 106 06 1.06 009 0.09 20 0. 03 3 0.3 08 8 0.8 ( −0. −0.0 07 0.7 04 10 1.0 0.9 6 1.4 11 1.1 −0 1. −