Do ACEIs/ARBs Affect Severity, Mortality Risk in Hospitalized COVID-19 Patients with Hypertension?

The effects of COVID-19 range from presenting no symptoms at all to death. As experts try to determine what patient factors may affect disease severity and mortality risk from patient to patient, a new study assessed the association between angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) and severity of illness and mortality in patients with hypertension hospitalized for COVID-19 infection.

“The use of ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) is common treatment in cardiovascular disorders, including hypertension, and data regarding the association of these drugs with ACE2 levels are conflicting. However, to our knowledge, there are no clinical data indicating whether patients with hypertension who are taking ACEIs/ARBs have increased severity of illness or risk of mortality during COVID-19 infection and whether these patients should continue to use ACEIs/ARBs or switch to other antihypertensive drugs,” the study authors stated.

Patients hospitalized with COVID-19 infections at the Central Hospital of Wuhan, China between January 15 and March 15 were retrospectively reviewed. Positive COVID-19 was determined using real-time reverse transcription–polymerase chain reaction and epidemiologic, clinical, radiologic, laboratory, and drug therapy data. The study authors compared the percentage of patients with hypertension taking ACEIs/ARBs between patients with severe versus nonsevere illness and survivors versus nonsurvivors.

ACEIs/ARBs Do Not Largely Influence Disease Severity, Mortality Risk

Final analysis included 1,178 COVID-19 patients (median age, 5.5 years; 46.3% were male). The in-hospital mortality rate was 11.0%. Just under a third of the total cohort had hypertension (n=362); in this subgroup, the median age was 66.0 years, 189 (52.2%) were male, and 11 (31.8%) were taking ACEIs/ARBs. Among the hypertension group, the in-hospital mortality rate was 21.3%. The rate of patients taking ACEIs/ARBs was not significantly different between patients with severe and nonsevere infections (32.9% vs. 30.7%; P=0.65) as well as nonsurvivors and survivors (27.3% vs. 33.0%; P=0.34). Outcomes were similar when assessing patients taking ACEIs and ARBs.

“The current findings did not identify an association between treatment with ACEIs/ARBs and either severity or clinical outcomes of COVID-19 hospitalizations in patients with hypertension. These data support current guidelines and societal recommendations for treating hypertension during the COVID-19 pandemic,” the researchers concluded.

The study results were published in JAMA Cardiology.