ACEIs/ARBs linked to reduced mortality in COVID-19

  • Zhang P & al.
  • Circ Res
  • 17 Apr 2020

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • In patients with COVID-19, angiotensin-converting enzyme (ACE) inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs) are linked to reduced mortality risk.
  • Results are from a retrospective study of in-hospital use of the drugs in China.

Why this matters

  • Because of the involvement of ACE receptors in SARS-CoV-2 infection, questions had arisen about whether patients with COVID-19 should continue these therapies.
  • Most cardiac societies have recommended continuation, but concerns have persisted.

Key results

  • 28-day all-cause mortality (unadjusted) was lower among patients taking ACEIs/ARBs:
    • 3.7% vs 9.8% among those not on these therapies (P=.01).
  • With adjustment, mortality risk was significantly lower in the ACEI/ARB group:
    • adjusted HR (aHR), 0.42 (95% CI, 0.19-0.92).
  • Among patients taking any antihypertensives, those taking ACEIs/ARBs still had decreased mortality vs those taking other antihypertensives:
    • aHR, 0.30 (95% CI, 0.13-0.71).
  • The pattern held in propensity score-matched analyses with several adjustments.
  • Patients taking ACEIs/ARBs also had reduced risk for septic shock vs those not taking them:
    • aHR, 0.36 (95% CI, 0.16-0.84).
  • Hypertension itself was, as expected, a risk factor for mortality:
    • aHR, 1.41 (95% CI, 1.03-1.94).

Study design

  • Retrospective study, 3430 patients (53.2% men; median age, 64 years) with COVID-19 at 9 hospitals in Hubei Province, China, December 31, 2019 to February 20, 2020.
  • 1128 had hypertension, of whom 188 were taking ACEIs/ARBs.
  • Funding: National Key R&D Program of China; others.

Limitations

  • Retrospective.
  • Not all other medications before or during hospitalization fully captured.