Continued In-Hospital Angiotensin-Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Use in Hypertensive COVID-19 Patients Is Associated With Positive Clinical Outcome. (23rd July 2020)

• Record Type: Journal Article
• Authors: Lam, Katherine W; Chow, Kenneth W; Vo, Jonathan; Hou, Wei; Li, Haifang; Richman, Paul S; Mallipattu, Sandeep K; Skopicki, Hal A; Singer, Adam J; Duong, Tim Q
• Is Part Of: Journal of infectious diseases. Volume 222:Number 8(2020)
• Page Start: 1256
• Page End: 1264
• Publication Date: 2020-07-23
• Subjects: angiotensin-converting enzyme inhibitors -- angiotensin II receptor blockers -- troponin -- hypotension -- acute kidney injury; Communicable diseases -- Periodicals; Diseases -- Causes and theories of causation -- Periodicals; Medicine -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.9
• DOI: 10.1093/infdis/jiaa447
• Languages: English
• ISSNs: 0022-1899

Abstract

Abstract: Background: This study investigated continued and discontinued use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB) during hospitalization of 614 hypertensive laboratory-confirmed COVID-19 patients. Methods: Demographics, comorbidities, vital signs, laboratory data, and ACEi/ARB usage were analyzed. To account for confounders, patients were substratified by whether they developed hypotension and acute kidney injury (AKI) during the index hospitalization. Results: Mortality (22% vs 17%, P > .05) and intensive care unit (ICU) admission (26% vs 12%, P > .05) rates were not significantly different between non-ACEi/ARB and ACEi/ARB groups. However, patients who continued ACEi/ARBs in the hospital had a markedly lower ICU admission rate (12% vs 26%; P = .001; odds ratio [OR] = 0.347; 95% confidence interval [CI], .187–.643) and mortality rate (6% vs 28%; P = .001; OR = 0.215; 95% CI, .101–.455) compared to patients who discontinued ACEi/ARB. The odds ratio for mortality remained significantly lower after accounting for development of hypotension or AKI. Conclusions: These findings suggest that continued ACEi/ARB use in hypertensive COVID-19 patients yields better clinical outcomes. Abstract : In hypertensive patients with COVID-19, in-hospital continuation of ACE inhibitors or ARBs is associated with lower rates of mortality and intensive care admission in the absence of hypotension or acute kidney injury.