Risk of severe COVID-19 in hypertensive patients treated with renin-angiotensin-aldosterone system inhibitors

Med Clin (Barc). 2020 Dec 11;155(11):488-490. doi: 10.1016/j.medcli.2020.06.013. Epub 2020 Jun 25.
[Article in English, Spanish]

Abstract

Introduction: There is controversy concerning the use of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II type-I receptor blockers (ARB) for treating hypertensive patients with Covid-19. It has been hypothesized that these drugs might increase the risk of severe Covid-19, but some authors suggested that blocking the renin-angiotensin system might actually decrease this risk.

Methods: Retrospective cohort study of all the consecutive hypertensive patients with confirmed SARS-CoV-2 infection in a health area. The outcome variable was hospitalization because of severe Covid-19.

Results: 539 subjects were diagnosed of SARS-CoV-2 infection. Of these, 157 (29.1%) had hypertension and were included in the study. Sixty-nine cases (43.9%) were hospitalized because of severe Covid-19. In multivariable analysis older age, diabetes and hypertensive myocadiopathy were related to a higher risk of hospital admission. ARB treatment was associated with a significantly lower risk of hospitalization (HR: 0.29, 95% CI: 0.10 - 0.88). A similar albeit not significant trend was observed for ACEI.

Conclusion: ARB or ACEI treatment was not associated with a worse clinical outcome in consecutive hypertensive patients infected by SARS-CoV-2.

Introducción: Existe controversia respecto al uso de los inhibidores de la enzima convertidora de angiotensina (IECA) o los bloqueadores de los receptores tipo I de la angiotensina II (ARA-II) para el tratamiento de la hipertensión arterial en COVID-19. Se ha sugerido que estos fármacos podrían tanto aumentar como reducir el riesgo de COVID-19 grave.

Pacientes y método: Estudio de cohortes retrospectivo de pacientes consecutivos de un área sanitaria, con hipertensión e infección por SARS-CoV-2. Variable de resultados: ingreso hospitalario por COVID-19 grave.

Resultados: Fueron diagnosticados 539 sujetos por infección por SARS-CoV-2. De estos, 157 (29,1%) eran hipertensos y se incluyeron en el estudio. Se ingresaron 69 (43,9%) pacientes por COVID-19 grave. En el análisis multivariante, la edad más elevada, la diabetes y la miocardiopatía hipertensiva se relacionaron con el riesgo de ingreso hospitalario. El tratamiento con ARA-II se asoció con un riesgo significativamente más bajo de ingreso (HR: 0,29, IC 95%: 0,10-0,88). Una tendencia similar, aunque no significativa, se encontró para los IECA.

Conclusión: el tratamiento con ARA-II o IECA no se asoció con una peor evolución clínica en pacientes hipertensos consecutivos infectados por SARS-CoV-2.

Keywords: Angiotensin II type-I receptor blockers; Angiotensin-converting enzyme inhibitors; Bloqueadores tipo I de angiotensina-II; COVID-19; Hipertensión; Hypertension; Inhibidores de la enzima convertidora de angiotensina.

MeSH terms

  • Age Factors
  • Aged
  • Angiotensin II Type 1 Receptor Blockers / adverse effects*
  • Angiotensin II Type 1 Receptor Blockers / therapeutic use
  • COVID-19 / epidemiology*
  • Cardiomyopathies / complications
  • Diabetes Complications
  • Female
  • Hospitalization
  • Humans
  • Hypertension / drug therapy*
  • Male
  • Multivariate Analysis
  • Prognosis
  • Retrospective Studies
  • SARS-CoV-2*

Substances

  • Angiotensin II Type 1 Receptor Blockers