Continued in-hospital angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker use in hypertensive COVID-19 patients is associated with positive clinical outcome

Abstract

Background. This study investigated continued and discontinued use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB) during hospitalization of 614 hypertensive laboratory-confirmed COVID-19 patients. Methods. Demographics, comorbidities, vital signs, laboratory data, and ACEi/ARB usage were analyzed. To account for confounders, patients were substratified by whether they developed hypotension and acute kidney injury (AKI) during the index hospitalization. Results. Mortality (22% vs 17%, P >.05) and intensive care unit (ICU) admission (26% vs 12%, P >.05) rates were not significantly different between non-ACEi/ARB and ACEi/ARB groups. However, patients who continued ACEi/ARBs in the hospital had a markedly lower ICU admission rate (12% vs 26%; P =.001; odds ratio [OR] = 0.347; 95% confidence interval [CI],.187-.643) and mortality rate (6% vs 28%; P =.001; OR = 0.215; 95% CI,.101-.455) compared to patients who discontinued ACEi/ARB. The odds ratio for mortality remained significantly lower after accounting for development of hypotension or AKI. Conclusions. These findings suggest that continued ACEi/ARB use in hypertensive COVID-19 patients yields better clinical outcomes.