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ACEI/ARB Use is Associated with Reduced Mortality in COVID-19 Inpatients
19 Pages Posted: 2 Aug 2021
More...Abstract
Background: Angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) upregulate angiotensin-converting enzyme 2, the functional receptor for SARS-CoV-2, and therefore, can affect COVID-19 outcome.
Methods To examine outcome among patients with COVID-19, a case control study was conducted at Maimonides Medical Center for patients admitted from February 1, 2020 to March 31, 2021. Baseline characteristics, comorbidities, concomitant pharmacotherapy, primary and secondary outcome, and lab profile were compared between patients who received inpatient ACEI/ARB use and those who did not in all patients, and subpopulation of patients when concomitant use of hydroxychloroquine, Tocilizumab, Remdesivir or dexamethasone was excluded. Primary outcome was also compared in subgroup of patients with hypertension, coronary artery disease, or congestive heart failure.
Findings Among the 4854 patients admitted with COVID-19, 571 patients (11.8%) received inpatient ACEI/ARB, and 4283 patients (88.2%) did not. The ACEI/ARB group were older, had more male patients, and had more cardiovascular comorbidities. The 30-day and 90-day mortality for ACEI/ARB users were 14.71% and 15.41%, whereas the 30-day and 90-day mortality for non-users were 21.9% and 22.53%. The mortality benefit associated with ACEI/ARB use sustained when concomitant use of Remdesivir, hydroxychloroquine, Tocilizumab, or dexamethasone was excluded. Inpatient ACEI/ARB use was also associated with a relative mortality reduction of 40-45% at 30 and 90 days in patients with hypertension, coronary artery disease or congestive heart failure. The above differences in mortality between ACEI/ARB users and non-users were statistically significant except when concomitant use of dexamethasone was excluded.
Interpretation: Inpatient use of ACEI/ARBs is associated with reduced mortality in COVID-19 patients; unless contraindicated, admitted COVID-19 patients should receive ACEI or ARB to improve outcome.
Funding: None to declare.
Declaration of Interest: None to declare.
Ethical Approval: The study is approved by IRB at Maimonides Medical Center
Suggested Citation: Suggested Citation