Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Withdrawal Is Associated with Higher Mortality in Hospitalized Patients with COVID-19.
Emilia Roy-VallejoAquilino Sánchez PurificaciónJosé David Torres PeñaBeatriz Sánchez MorenoFrancisco Arnalich FernándezMaría José García BlancoJose Lopez-MirandaJuan Luis Romero-CabreraCarmen Rosario Herrero GilJosé BascunanaManuel Rubio-RivasSara Pintos OteroVerónica Martínez SempereJesús Ballano Rodríguez-SolísRicardo Gil SánchezJairo Luque Del PinoAmara González NoyaMaría Sierra Navas-AlcántaraBegoña Cortés RodríguezJosé Nicolás AlcaláAna Suárez-LombrañaJorge Andres SolerRicardo Gómez HuelgasJosé Manuel Casas-RojoJesús Millán Núñez-Cortésnull On Behalf Of The Semi-Covid-NetworkPublished in: Journal of clinical medicine (2021)
Our main aim was to describe the effect on the severity of ACEI (angiotensin-converting enzyme inhibitor) and ARB (angiotensin II receptor blocker) during COVID-19 hospitalization. A retrospective, observational, multicenter study evaluating hospitalized patients with COVID-19 treated with ACEI/ARB. The primary endpoint was the incidence of the composite outcome of prognosis (IMV (invasive mechanical ventilation), NIMV (non-invasive mechanical ventilation), ICU admission (intensive care unit), and/or all-cause mortality). We evaluated both outcomes in patients whose treatment with ACEI/ARB was continued or withdrawn. Between February and June 2020, 11,205 patients were included, mean age 67 years (SD = 16.3) and 43.1% female; 2162 patients received ACEI/ARB treatment. ACEI/ARB treatment showed lower all-cause mortality (p < 0.0001). Hypertensive patients in the ACEI/ARB group had better results in IMV, ICU admission, and the composite outcome of prognosis (p < 0.0001 for all). No differences were found in the incidence of major adverse cardiovascular events. Patients previously treated with ACEI/ARB continuing treatment during hospitalization had a lower incidence of the composite outcome of prognosis than those whose treatment was withdrawn (RR 0.67, 95%CI 0.63-0.76). ARB was associated with better survival than ACEI (HR 0.77, 95%CI 0.62-0.96). ACEI/ARB treatment during COVID-19 hospitalization was associated with protection on mortality. The benefits were greater in hypertensive, those who continued treatment, and those taking ARB.
Keyphrases
- angiotensin converting enzyme
- angiotensin ii
- intensive care unit
- mechanical ventilation
- cardiovascular events
- end stage renal disease
- newly diagnosed
- emergency department
- ejection fraction
- chronic kidney disease
- risk factors
- type diabetes
- prognostic factors
- metabolic syndrome
- cardiovascular disease
- coronary artery disease
- patient reported
- extracorporeal membrane oxygenation