Key result
ACEI and ARB use does not increase in-hospital mortality vs nonusers in hospitalized COVID-19 patients.
Why the study?
Concerns were raised early in the COVID-19 pandemic about potential adverse outcomes in patients taking ACEIs/ARBs based on animal studies showing increased ACE-2 expression.
Does the use of ACEIs and/or ARBs impact in-hospital mortality, ICU admission, hemodialysis requirement, and mechanical ventilation in hospitalized patients with COVID-19?
Cohort (n=289)
No
Does the use of ACEIs and/or ARBs impact in-hospital mortality, ICU admission, hemodialysis requirement, and mechanical ventilation in hospitalized patients with COVID-19?
Absolute Event Rate: 32.9% vs 15.2%
p-value: p=0.7141
The use of ACEIs and ARBs in patients hospitalized with COVID-19 does not significantly increase the risk of in-hospital mortality, ICU admission, hemodialysis, or mechanical ventilation.
May support continued ACEI/ARB use in hospitalized COVID-19; leaves open confirmation by randomized trials.
Early during the Coronavirus disease 2019 (Covid-19) pandemic, concerns were raised regarding potential adverse outcomes in patients taking angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs). These concerns were based on animal studies showing increased ACE-2 expression in mice treated with ACEI/ARB. This is a single-center, retrospective, cohort study of 289 patients diagnosed with 2019 Novel Coronavirus (SARS-CoV-2) hospitalized between March of 2020 and June of 2020. The study was intended to investigate the impact of ACEIs and/or ARBs on in-hospital mortality, intensive care unit (ICU) admission, postadmission hemodialysis requirement, and the need for mechanical ventilation in patients with COVID-19. This cohort of 289 patients included 139 of 289 women (48%) with a mean age of 61 ± 19 years. Patients using ACEIs/ARBs were older (69.68 vs. 57.9 years; P < 0.0001), more likely to have a history of hypertension (97% vs. 36%; P < 0.0001), diabetes mellitus (48% vs. 20.9%; P < 0.0001), chronic heart failure (11.39% vs. 4.29%; P < 0.0512), coronary artery disease (20.25% vs. 7.14%; P < 0.0025), stroke/Transient Ischemic Attack (7.59% vs. 2.38%; P < 0.0761), chronic kidney disease (11.39% vs. 3.33%; P < 0.0167), atrial fibrillation/flutter (18.99% vs. 7.14%; P < 0.0080), and dementia (22.7% vs. 11.4%; P < 0.0233) compared with the nonuser group. There was significantly higher in-hospital mortality in patients using ACEIs/ARBs than nonusers, respectively (32.9% vs. 15.2%; P < 0.0015). However, a multivariate logistics regression analysis performed to adjust for common confounders demonstrated no significant difference in all-cause in-patient mortality (P 0.7141). Admission to ICU, postadmission hemodialysis requirement, and mechanical ventilation showed no significant differences between the 2 groups (P = NS). This study suggests that the use of ACEIs and ARBs in patients with COVID-19 was not found to significantly increase all-cause in-hospital mortality, ICU admissions, and hemodialysis and mechanical ventilation requirements.
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A 2021 study conducted a cohort in COVID-19 (n=289). ACEIs and/or ARBs vs. nonusers was evaluated on all-cause in-hospital mortality (p=0.7141). Use of ACEIs and ARBs in hospitalized COVID-19 patients did not significantly increase adjusted all-cause in-hospital mortality compared to nonusers (32.9% vs 15.2% unadjusted; adjusted P=0.7141).
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