Key result
Chronic RAAS inhibitor use linked to ~75% lower ICU admission rate in COVID-19.
Why the study?
The effect of chronic use of RAAS inhibitors on the severity of COVID-19 infection in hypertensive patients was still unclear.
Does chronic use of RAAS inhibitors affect COVID-19-related outcomes in hypertensive patients?
Cohort (n=133)
No
Does chronic use of RAAS inhibitors affect COVID-19-related outcomes in hypertensive patients?
Chronic use of RAAS inhibitors in hypertensive patients with COVID-19 does not worsen clinical outcomes and may be associated with a lower risk of ICU admission.
Answers are grounded in this paper and cite their sources.
May support continuing RAAS inhibitors in hypertensive COVID-19 patients; hypothesis-generating for reduced ICU admission pending RCTs.
BACKGROUND: The effect of chronic use of renin-angiotensin-aldosterone system (RAAS) inhibitors on the severity of COVID-19 infection is still unclear in patients with hypertension. We aimed to investigate the association between chronic use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) and COVID-19-related outcomes in hypertensive patients. METHODS: A single-center study was conducted on 133 consecutive hypertensive subjects presenting to the emergency department with acute respiratory symptoms and/or fever who were diagnosed with COVID-19 infection between 9 and 31 March 2020. RESULTS: All patients were grouped according to their chronic antihypertensive medications (ACEIs, N = 40; ARBs, N = 42; not on RAAS inhibitors, N = 51). There was no statistical difference between ACEIs and ARBs groups in terms of hospital admission rate, oxygen therapy, and need for noninvasive ventilation. Patients chronically treated with RAAS inhibitors showed a significantly lower rate of admission to semi-intensive/intensive care units, when compared with the non-RAAS population (odds ratio (OR) 0.25, confidence interval (CI) 95% 0.09-0.66, P = 0.006). Similarly, the risk of mortality was lower in the former group, although not reaching statistical significance (OR 0.56, CI 95% 0.17-1.83, P = 0.341). CONCLUSIONS: Our data suggest that chronic use of RAAS inhibitors does not negatively affect clinical course of COVID-19 in hypertensive patients. Further studies are needed to confirm this finding and determine whether RAAS inhibitors may have a protective effect on COVID-19-related morbidity and mortality.
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Felice et al. (2020) conducted a cohort in COVID-19 and hypertension (n=133). Chronic use of RAAS inhibitors (ACEIs or ARBs) vs. Not on RAAS inhibitors was evaluated on Admission to semi-intensive/intensive care units (OR 0.25, 95% CI 0.09-0.66, p=0.006). Chronic use of RAAS inhibitors in hypertensive patients with COVID-19 was associated with a lower rate of admission to semi-intensive/intensive care units.
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