ACEIs/ARBs and Risk of Death in COVID-19 Patients With Hypertension

Quick Takes

  • Patients with HTN have a higher risk of severe illness and in-hospital mortality with COVID-19 infection.
  • Among patients with HTN, there was no difference in illness severity or in-hospital mortality among those taking ACEIs/ARBs as compared to those taking other types of antihypertensive medications.
  • These data support current recommendations for the treatment of HTN.

Study Questions:

Do patients with hypertension (HTN) who are taking angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) have an increased mortality risk during hospitalization for coronavirus disease 2019 (COVID-19)?

Methods:

The authors used a retrospective, single-center case series to examine the association of disease severity and mortality during hospitalization for COVID-19 and the use of ACEIs or ARBs. A total of 1,178 patients hospitalized at one center (Central Hospital) in Wuhan, China, between January 15-March 15, 2020, were included in this case series. All patients had confirmed COVID-19 infection, confirmed by reverse transcription polymerase chain reaction. The primary outcomes of interest were COVID illness severity and in-hospital mortality.

Results:

Of the 1,178 patients with documented COVID-19 infection, the median age was 55.5 years, and 545 (46.3%) were men. The overall in-hospital mortality was 11.0%. From the total cohort, 362 (30.7%) patients had a history of HTN, median age 66.0 years, and 189 (52.2.%) were men. Of those with HTN, 115 (31.8%) were taking ACEIs or ARBs. Patients with HTN were older and more likely to have other chronic conditions. In-hospital mortality in patients with HTN was 21.3%, which was higher than those without HTN (6.5%). The percentage of patients with HTN taking ACEIs/ARBs did not differ between those with severe and nonsevere infections (32.9% vs. 30.7%; p = 0.645) nor did it differ between nonsurvivors and survivors (27.3% vs. 33.0%; p = 0.34). Similar findings were observed when data were analyzed for patients taking ACEIs and those taking ARBs. There was also no difference in comorbidities associated with HTN or length of hospital stay among patients taking ACEIs/ARBs versus other antihypertensive medications.

Conclusions:

Data from this large case series suggest that ACEIs/ARBs are not associated with the severity or mortality of COVID-19. These data support current guidelines and societal recommendations for treating hypertension during the COVID-19 pandemic.

Perspective:

As observed in other studies, patients with HTN were more likely to have a severe illness related to COVID-19 and higher mortality rates compared with patients who did not have HTN. However, these data do not support an association between ACEIs/ARB use and mortality or infection severity. Ongoing and future research related to ACEI/ARBs will likely assist in understanding optimal treatment of COVID-19 infection; in particular, among patients with HTN or cardiovascular conditions.

Clinical Topics: Prevention, Hypertension

Keywords: Angiotensin-Converting Enzyme Inhibitors, Angiotensin Receptor Antagonists, Antihypertensive Agents, Comorbidity, Coronavirus, COVID-19, Hospital Mortality, Hypertension, Pandemics, Primary Prevention, Reverse Transcription, severe acute respiratory syndrome coronavirus 2


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