Mortality in Patients with COVID-19 on Renin Angiotensin System Inhibitor Long-Term Treatment: An Observational Study Showing that Things Are Not Always as They Seem

Abstract

Introduction At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, controversial data were reported concerning angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) that induced a number of physicians to stop using them in patients with COVID-19. Although large-scale studies have ruled out this concern, it is common experience that patients with COVID-19 taking ACE inhibitors or ARBs are at increased risk of death. The aim of this study was to investigate the reasons for this apparently high mortality rate. Methods During the first wave of the pandemic, we conducted a field study of 427 consecutive patients with COVID-19 upon their admission to the emergency department of a hospital in one of the most severely hit cities in northern Italy, and 30 days later. The disease was defined as being mild, moderate or severe on the basis of clinical, laboratory and imaging data, and a multivariate model was used to analyse the determinants of mortality. Results Within 30 days of admission, 31.6% of the patients treated with ACE inhibitors or ARBs and 15.2% of those not treated with these drugs had died. Multivariate analysis showed that the determinants of mortality were age ( p = 0.0001), hypertension ( p = 0.0120) and diabetes ( p = 0.0129), whereas ACE inhibitors or ARBs had no effect on mortality. There was no significant difference between the patients treated with ACE inhibitors and those treated with ARBs. Conclusion The apparently increased mortality of patients with COVID-19 receiving long-term treatment with ACE inhibitors or ARBs is not due to the drugs themselves, but to the conditions associated with their use.

Renin‐Angiotensin Aldosterone System Inhibitors and COVID‐19: A Systematic Review and Meta‐Analysis Revealing Critical Bias Across a Body of Observational Research

“…The systematic search identified 169 observational studies that assessed the associations between RAAS inhibitor use and the risk of contracting a SARS‐CoV‐2 infection and/or experiencing severe COVID‐19 outcomes (Figure 1 ). 8 , 19 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , …”

Risk Factors Associated with COVID-19 Hospitalization and Mortality: A Large Claims-Based Analysis Among People with Type 2 Diabetes Mellitus in the United States

“…However, most of the reviewed studies were not exclusively examining a T2D population, and limited prospective evidence on this topic remains. It has also been suggested that there may be an increased risk of COVID-19 mortality associated with patients receiving long-term treatment with ARBs that is due to the conditions associated with their use, including diabetes, rather than the drugs themselves [ 39 ]. Future research is needed that directly accounts for duration of T2D in the context of medication class effects.…”

Raas Antagonists in the Treatment of Arterial Hypertension in Patients With Covid-19-Associated Pneumonia

“…У нашому дослідженні у пацієнтів, які приймали іАПФ, порівняно з пацієнтами, які приймали БРА, спостерігалася тенденція до меншої потреби у кисневій терапії, хоча статистично при цьому достовірної різниці не встановлено (р=0,07). У дослідженні, в якому порівнювали летальність та важкість перебігу коронавірусної хвороби COVID-19 у пацієнтів, які приймали іАПФ, та у пацієнтів, які приймали БРА, не виявлено суттєвої різниці у цих показниках [11].…”