Association of ACEi/ARB Use and Clinical Outcomes of COVID-19 Patients With Hypertension

Jing Ma; Xiaowei Shi; Jiong Yu; Feifei Lv; Jian Wu; Xinyu Sheng; Qiaoling Pan; Jinfeng Yang; Hongcui Cao; Lanjuan Li

doi:10.3389/fcvm.2021.577398

Association of ACEi/ARB Use and Clinical Outcomes of COVID-19 Patients With Hypertension

Front Cardiovasc Med. 2021 May 31:8:577398. doi: 10.3389/fcvm.2021.577398. eCollection 2021.

Authors

Jing Ma^{1

2

3}, Xiaowei Shi^{1

2}, Jiong Yu^{1

2}, Feifei Lv³, Jian Wu^{1

4}, Xinyu Sheng^{1

2}, Qiaoling Pan^{1

2}, Jinfeng Yang^{1

2}, Hongcui Cao^{1

2}, Lanjuan Li^{1

2}

Affiliations

¹ State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
² Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
³ Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
⁴ Department of Laboratory Medicine, The First People's Hospital of Yancheng City, Yancheng, China.

Abstract

Objectives: Evidence has shown that angiotensin-converting enzyme 2 (ACE2), which can be upregulated after angiotensin-converting enzyme inhibitor (ACEi) and angiotensin receptor blocker (ARB) treatment, may play a dual role in the pathogenesis and progression of coronavirus disease 2019 (COVID-19). We aimed to assess the association between the use of ACEi/ARB and the outcome of COVID-19 patients with preexisting hypertension in non-endemic areas. Methods: From January 17, 2020, to February 19, 2020, 286 patients with hypertension were enrolled in this retrospective study out of 1,437 COVID-19 patients from 47 centers in Zhejiang and Jiangsu Province. The composite endpoints consisted of mechanical ventilation, intensive care unit (ICU) admission, or death. Cox proportional hazards analysis was performed to assess the association between ACEi/ARB and clinical outcomes of COVID-19 patients with hypertension. Results: In the main analysis, 103 patients receiving ACEi/ARB were compared with 173 patients receiving other regimens. Overall, 44 patients (15.94%) had an endpoint event. The risk probability of crude endpoints in the ACEi/ARB group (12.62%) was lower than that in the non-ACEi/ARB group (17.92%). After adjusting for confounding factors by inverse probability weighting, the results showed that the use of ACEi/ARB reduced the occurrence of end events by 47% [hazard ratio (HR) = 0.53; 95% CI, 0.34-0.83]. Similar results were obtained in multiple sensitivity analyses. Conclusions: In this retrospective study, among COVID-19 patients with hypertension, the use of ACEi/ARB is not associated with an increased risk of disease severity compared with patients without ACEi/ARB. The trends of beneficial effects of ACEi/ARB need to be further evaluated in randomized clinical trials.

Keywords: COVID-19; SARS-CoV-2; angiotensin receptor blockers; angiotensin-converting enzyme inhibitors; hypertension.