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A Retrospective Study from 2 Centers in China on the Effects of Continued Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers in Patients with Hypertension and COVID-19

Zhongchao Wang, Dewei Zhang, Shengming Wang, Yanhua Jin, Jianbo Huan, Yue Wu, Cheng Xia, Zhe Li, Xingshun Qi, Duanzhen Zhang, Xiumin Han, Xianyang Zhu, Ying Qu, Qiguang Wang

Department of Congenital Heart Disease, General Hospital of Northern Theater Command, Shenyang, Liaoning, China (mainland)

Med Sci Monit 2020; 26:e926651

DOI: 10.12659/MSM.926651

Available online: 2020-08-10

Published: 2020-09-24

BACKGROUND: Use of renin-angiotensin-aldosterone system inhibitors in coronavirus disease 2019 (COVID-19) patients lacks evidence and is still controversial. This study was designed to investigate effects of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) on clinical outcomes of COVID-19 patients and to assess the safety of ACEIs/ARBs medication.
MATERIAL AND METHODS: COVID-19 patients with hypertension from 2 hospitals in Wuhan, China, from 17 Feb to 18 Mar 2020 were retrospectively screened and grouped according to in-hospital medication. We performed 1: 1 propensity score matching (PSM) analysis to adjust for confounding factors.
RESULTS: We included 210 patients and allocated them to ACEIs/ARBs (n=81; 46.91% males) or non-ACEIs/ARBs (n=129; 48.06% males) groups. The median age was 68 [interquartile range (IQR) 61.5-76] and 66 (IQR 59-72.5) years, respectively. General comparison showed mortality in the ACEIs/ARBs group was higher (8.64% vs. 3.88%) but the difference was not significant (P=0.148). ACEIs/ARBs was associated with significantly more cases 7-categorical ordinal scale >2 at discharge, more cases requiring Intensive Care Unit (ICU) stay, and increased values and ratio of days that blood pressure (BP) was above normal range (P<0.05). PSM analysis showed no significant difference in mortality, cumulative survival rate, or other clinical outcomes such as length of in-hospital/ICU stay, BP fluctuations, or ratio of adverse events between groups after adjustment for confounding parameters on admission.
CONCLUSIONS: We found no association between ACEIs/ARBs and clinical outcomes or adverse events, thus indicating no evidence for discontinuing use of ACEIs/ARBs in the COVID-19 pandemic.

Keywords: angiotensin receptor antagonists, Angiotensin-Converting Enzyme Inhibitors, Blood Pressure, COVID-19, Hypertension