No Difference in COVID-19 Severity, Rate of Death Based on ACEi/ARBs

A new analysis from the Central Hospital of Wuhan has found no difference in outcomes among hypertensive patients with coronavirus disease 2019 (COVID-19) based on whether or not they were taking angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs).

Despite some speculation based on early data, the current study, which included more than 300 patients with hypertension over a 1-month, found no difference in disease severity or risk of death in hospitalized patients with COVID-19.

As the link between SARS-CoV-2 and ACE2 established by multiple studies early on in the outbreak, the debate over the use of ACEi/ARBs is one that has drawn the attention of nearly every cardiologist and cardiology organization. With this in mind, investigators from the Central Hospital of Wuhan sought to assess the impact of ACEi/ARBs use in patients hospitalized with the disease from January 15 to March 15, 2020.

Of note, COVID-19 diagnosis was confirmed by RT-PCR and the primary outcome of the study was the percentage of patients with hypertension taking ACEi/ARBs compared between those with severe or nonsevere illness and between survivors and nonsurvivors.

For the purpose of the analysis, severe illness was defined as blood oxygen saturation levels of 93% or less, respiratory frequency of 30 per minute or greater, a partial pressure of arterial oxygen to fraction of inspired oxygen ratio of less than 300lung infiltrates more than 50% within 24 to 48 hours, septic shock, respiratory failure, and/or multiple organ dysfunction or failure. Investigators defined nonsevere illnesses as the absence of the aforementioned characteristics.

During this time period, 1178 patients were hospitalized with COVID-19. Mean age of the cohort was 55.5 years and 46.3% were women. Among this group, investigators identified 362 patients with hypertension, which was defined as a history of diastolic blood pressure of 90 mmHg or greater, a systolic blood pressure of 140 mmHg or greater, or a history of antihypertensive use.

Of the 362 patients with hypertension, 52.2% were men, 71.5% were older than 60 years of age, 31.8% (n=115) were taking ACEi/ARBs, and patients had an in-hospital mortality rate of 21.3%. Investigators pointed out the percentage of patients raking any drug or drug combination did not differentiations among those with severe and nonsecure infections and nonsurvivors and survivors.

When assessing the impact of ACEi/ARB use, investigators found no difference between those with severe and nonsecure illness based on use of ACEi (9.2% vs 10.1%; P=.80), ARBs (24.9% vs 21.2%; P=.40) or a composite of ACEi/ARBs (32.9% vs 30.7%; P=.65). Additionally, there were no differences observed between survivors and nonsurvivors based on use of ACEi (9.1% vs 9.8%; P=.85), ARBs (19.5% vs 23.9%; P=.42), or a composite of both (27.3% vs 33.0%; P=.34).

Investigators pointed out multiple limitations within their retrospective analysis. Limitations included a small number of patients taking ACEi/ARBs and inability to generalize results to all patients with hypertension.

This study, “Association of Renin-Angiotensin System Inhibitors With Severity or Risk of Death in Patients With Hypertension Hospitalized for Coronavirus Disease 2019 (COVID-19) Infection in Wuhan, China,” was published in JAMA Cardiology.