Use of RAAS Inhibitors and Risk of Clinical Deterioration in COVID-19: Results From an Italian Cohort of 133 Hypertensives

Abstract

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 9th and 31st 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 non-invasive ventilation. Patients chronically treated with RAAS inhibitors showed a significantly lower rate of admission to semi-intensive/intensive care units, when compared to the non-RAAS population (odds ratio [OR] 0.25, CI95% 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, CI95% 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.

Severity of COVID-19 Infection in ACEI/ARB Users in Two Saudi Public Specialty Hospitals; Retrospective Cohort Study

“…For example, in a study by Mehta et al in the United States, showed no signi cant association between ACEI/ARB use and mortality, while it reported potential harmful effects with ACEI/ARB use including higher hospital and ICU admissions [20]. Another study in France by Liabeuf [21]. Interestingly, in another large cohort study from the UK, Black Africans on ACEI/ARB were found to have higher risk of COVID-19 disease [50].…”

“…Certainly, the contradictory ndings reported in different populations with regards to the severity of COVID-19 may suggest population differences at play [20][21][22][23] [47][48][49]. For example, in a study by Mehta et al in the United States, showed no signi cant association between ACEI/ARB use and mortality, while it reported potential harmful effects with ACEI/ARB use including higher hospital and ICU admissions [20].…”

“…It has been hypothesized that exposing patients to ACEI/ARB may increase the expression of ACE2 by a negative feedback mechanism, thus facilitating the binding process of coronavirus to epithelial cells of the kidney, intestine, lung, and blood vessels [15] and increasing the risk of developing severe and fatal COVID-19 disease [16][17][18]. Clinical research evidence to date has been equivocal, especially in terms of identifying differentiating factors that may mediate the ACEI/ARB and COVID-19 severity relationship [19][20][21][22][23].…”

The therapeutic effect and safety of the drugs for COVID-19: a systematic review and meta-analysis

“…The screening process was shown in figure 1 and 3860 studies were identified according to the research strategy initially. In total, 22 studies containing 12795 patients were adopted in our study and all of them were published in English 10,12,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] . Among trails included, half of them were RCTs, and the other were Non-RCTs.…”

Renin-Angiotensin System Inhibitors in COVID-19: Current Concepts

“…Unfortunately, the number of patients who were on ACE-I/ARB therapy was too small (19/187) to reach any conclusion [ 4 ]. Similarly, few other observational studies have failed to demonstrate any association between the use of ACE-I/ARB and increased risk and severity of infection with SARS-CoV-2 [ 17 – 19 ].…”