Background:
Concerns exist that angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs) increase susceptibility to coronavirus SARS CoV-2 (the virus that causes the disease COVID-19) and the likelihood of severe COVID-19 illness.
Methods:
This is a single-center retrospective cohort study of 172 patients diagnosed with 2019 Novel Coronavirus (SARS-CoV-2) between March of 2020 and May of 2020. Our study aimed to investigate the impact of ACEI and/or ARBs on the in-hospital mortality, intensive care unit (ICU) admission, hospital length of stay (LOS), and ICU LOS of patients with COVID-19.
Results:
This cohort of 172 patients included 88 (51%) women with a mean age of 58±17 years. Patients who had a history of using ACEI/ARBs were older 68±14 vs. 54±17 (P<0.0001). They were more likely to be obese 28(65%) vs. 52(40%) p=0.0054, have hypertension 44(100%) vs 42(33%) p<0.0001, diabetes mellitus 18(40%) vs 13 (10%) p<0.0001, and chronic kidney disease 5(11%) vs. 1(0.8%) p= 0.0011 than patients not using ACEI/ARBs. On the other hand, the prevalence of coronary artery disease (p=0.3791), and chronic heart failure (p=0.8037) was similar between the two groups.
Outcomes:
There was significantly higher in-hospital mortality in patients who used ACEI/ARBs than non-users (33% vs. 13%, p=0.0039, respectively). To evaluate the effect of ACEI/ARBs on mortality after controlling for confounding factors, multivariable logistic regression (MLR) was performed based on age (p=0.0003), obesity (p=0.3394), hypertension (p=0.4159), diabetes mellitus (p=0.0144), and chronic kidney disease (0.3189). The MLR showed no significant differences in mortality between patients who used ACEI/ARBs and non-users (p= 0.8372). Admission to ICU was more likely in patients who used ACEI/ARBs than non-users (28% vs. 13%, p=0.0384 respectively), while hospital LOS (6±9 vs. 4±6, p=0.1240 respectively), and ICU LOS (12±12 vs. 8±5, p= 0.3253 respectively) were similar between the two groups.
Conclusion:
This study suggests that the use of ACEI/ARBs associated with higher mortality in patients with COVID-19. This is likely attributed to the fact that patients who use these medications are older and are more likely to have diabetes mellitus and hypertension.
Angiotensin-converting enzyme inhibitors and receptor blockers in heart failure and chronic kidney disease – Demystifying controversies
