Association of Inpatient Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Mortality Among Patients With Hypertension Hospitalized With COVID-19
By Peng Zhang, Lihua Zhu, Jingjing Cai, Fang Lei, Juan-Juan Qin, Jing Xie, Ye Liu, Yan-Ci Zhao, Xuewei Huang, Lijin Lin and 34 more. Circulation Research, 2020
1,046 citations recorded by the source corpus.
Supplemental Digital Content is available in the text. Rationale: Use of ACEIs (angiotensin-converting enzyme inhibitors) and ARBs (angiotensin II receptor blockers) is a major concern for clinicians treating coronavirus disease 2019 (COVID-19) in patients with hypertension. Objective: To determine the association between in-hospital use of ACEI/ARB and all-cause mortality in patients with hypertension and hospitalized due to COVID-19. Methods and Results: This retrospective, multi-center study included 1128 adult patients with hypertension diagnosed with COVID-19, including 188 taking ACEI/ARB (ACEI/ARB group; median age 64 [interquartile range, 55–68] years; 53.2% men) and 940 without using ACEI/ARB (non-ACEI/ARB group; median age 64 [interquartile range 57–69]; 53.5% men), who were admitted to 9 hospitals in Hubei Province, China from December 31, 2019 to February 20, 2020. In mixed-effect Cox model treating site as a random effect, after adjusting for age, gender, comorbidities, and in-hospital medications, the detected risk for all-cause mortality was lower in the ACEI/ARB group versus the non-ACEI/ARB group (adjusted hazard ratio, 0.42 [95% CI, 0.19–0.92]; P=0.03). In a propensity score-matched analysis followed by adjusting imbalanced variables in mixed-effect Cox model, the results consistently demonstrated lower risk of COVID-19 mortality in patients who received ACEI/ARB versus those who did not receive ACEI/ARB (adjusted hazard ratio, 0.37 [95% CI, 0.15–0.89]; P=0.03). Further subgroup propensity score-matched analysis indicated that, compared with use of other antihypertensive drugs, ACEI/ARB was also associated with decreased mortality (adjusted hazard ratio, 0.30 [95% CI, 0.12–0.70]; P=0.01) in patients with COVID-19 and coexisting hypertension. Conclusions: Among hospitalized patients with COVID-19 and coexisting hypertension, inpatient use of ACEI/ARB was associated with lower risk of all-cause mortality compared with ACEI/ARB nonusers. While study interpretation needs to consider the potential for residual confounders, it is unlikely that in-hospital use of ACEI/ARB was associated with an increased mortality risk.
Subfields: Clinical Psychology, Infectious Diseases, Neurology
View Paper: https://www.semanticscholar.org/paper/9545acb20de6d41efb9057614d4c3481357a8c67
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Citations in the corpus
- Insights into SARS-CoV-2 genome, structure, evolution, pathogenesis and therapies: Structural genomics approach (2020, neutral): “It would, therefore, be fair to conclude here that more laboratory and clinical evidence are required to establish the roles of antihypertensive agents, ACE2 expression outcomes of COVID-19 in patients with cardiovascular disease [126].”
- Role of angiotensin-converting enzyme 2 (ACE2) in COVID-19 (2020, background): “However, two large cohort studies showed that ACEIs/ARBs use was not associated with increased SARS-CoV-2 infection, but was associated with a lower risk of all-cause mortality in hospitalized patients [107, 108].”
- Collider bias undermines our understanding of COVID-19 disease risk and severity (2020, background): “This could lead to factors that increase risk of infection falsely appearing to be protective for severe progression (1,32).”
- Postmortem examination of COVID‐19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings in lungs and other organs suggesting vascular dysfunction (2020, result): “However, other experimental evidence has shown a protective effect of RAAS inhibition in COVID-19 patients,(47) and, in a recent retrospective clinical study, the use of ACE inhibitors and ARBs was associated with lower overall mortality among hospitalised COVID-19 patients with hypertension.(48) Al”