The effect of renin-angiotensin blockers on COVID-19 related mortality: A tertiary center's experience

Abstract

Background: The first reports on coronaviruse disease 2019 (COVID-19) revealed an exaggerated mortality rate in hypertensive patients. In this regard, concerns about angiotensin-converting enzyme (ACE) inhibitors’ and angiotensin-receptor blockers’ (ARBs) have been aroused. Our aim in this study was to evaluate the potential bad outcome effect of hypertension and anti-hypertensive therapy on COVID-19. Methods: 183 patients with polymerase-chain-reaction (PCR)-proven COVID-19, who were admitted to our hospital and consulted to cardiology department between 15th of March and 15th of April 2020 were included. Data were recruited from hospital records. Results: Thirty-two out of 183 patients with COVID-19 died in hospital. Hypertension incidence was not statistically different between patients who survived and died (76 [50.3%] vs 19 [59.4%, p = 0.352]). Although the usage rate of ACEI were similar among groups, ARB usage rate was significantly higher in patients who died than survived (11 [34.4%] vs 23 [15.2%], p = 0.011). Binary regression analysis showed an association between ARBs and mortality (OR: 0.032, 95% CI 1.045–2.623, p = 0.032). Conclusion: Our study confirmed previous concerns regarding a potential harmful effects of ARBs on COVID-19 related mortality.Kontext: První zprávy o onemocn?ní koronavirem v roce 2019 (coronavirus disease 2019, COVID-19) ukazovaly na zv?šenou mortalitu jedinc? s hypertenzí, co? vyvolalo obavy ohledn? u?ívání inhibitor? angiotenzin konvertujícího enzymu (ACEI) a blokátor? receptoru AT1 pro angiotenzin II (ARB). Cílem naší studie bylo posoudit mo?nost nep?íznivého vlivu onemocn?ní covid-19 na záva?nost hypertenze a ú?innost antihypertenzní lé?by. Metody: Do studie bylo za?azeno 183 pacient? s onemocn?ním covid-19 prokázan?m PCR testem, kte?í byli v období od 15. b?ezna do 15. dubna 2020 p?ijati do naší nemocnice a následn? odesláni na kardiologickou kliniku. Údaje byly získány z nemocni?ních záznam?. V?sledky: Celkem 32 ze 183 pacient? s onemocn?ním covid-19 zem?elo v nemocnici. Incidence hypertenze se mezi pacienty, kte?í p?e?ili a zem?eli, statisticky v?znamn? nelišila (76 [50,3 %] vs. 19 [59,4 %]; p = 0,352). I kdy? podíly pacient? u?ívajících inhibitory ACE byly v obou skupinách podobné, lé?iva ze skupiny ARB u?ívalo statisticky v?znamn? více pacient?, kte?í zem?eli, ne? t?ch, kte?í p?e?ili (11 [34,4 %] vs. 23 [15,2 %]; p = 0,011). Binární regresní anal?za prokázala souvislost mezi u?íváním ARB a mortalitou (OR: 0,032; 95% CI 1,045–2,623; p = 0,032). Záv?r: Naše studie potvrdila p?vodní obavy t?kající se mo?n?ch škodliv?ch ú?ink? lékové skupiny ARB na mortalitu v souvislosti v onemocn?ním covid-19.