Effect of in-hospital treatment with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on mortality and complications in patients hospitalized for COVID-19: a large Spanish cohort study

  1. Emilia Roy-Vallejo
  2. Aquilino Sánchez Purificación
  3. José David Torres Peña
  4. Beatriz Sánchez Moreno
  5. Francisco Arnalich
  6. María José García Blanco
  7. José López Miranda
  8. Juan Luis Romero Cabrera
  9. Carmen Rosario Herrero Gil
  10. J Bascunana
  11. Manuel Rubio-Rivas
  12. Sara Pintos Otero
  13. VerĂłnica MartĂ­nez Sempere
  14. JesĂşs Ballano RodrĂ­guez-SolĂ­s
  15. Ricardo Gil Sánchez
  16. Jairo Luque del Pino
  17. Amara González Noya
  18. MS Navas-Alcántara
  19. Begoña Cortés Rodríguez
  20. José N. Alcalá
  21. Ana Suárez-Lombraña
  22. Jorge Andrés Soler
  23. Ricardo GĂłmez Huelgas
  24. José Manuel Casas Rojo
  25. Jesús Millán Núñez-Cortés
  26. for the SEMI-COVID-19 Network^
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Abstract

Background

The use of ACEI (Angiotensin-Converting Enzyme Inhibitor) and ARB (Angiotensin II Receptor Blocker) in COVID-19 remains controversial. Our main aim was to describe the effect of ACEI/ARB treatment during COVID-19 hospitalization on mortality and complications.

Methods

Retrospective, observational, multicenter study, part of the SEMI-COVID-19 Registry, comparing patients with COVID-19 treated with ACEI/ARB during hospitalization to those not treated. The primary endpoint was incidence of the composite outcome of prognosis (IMV [Invasive Mechanical Ventilation], NIMV [Non-Invasive Mechanical Ventilation], ICU admission [Intensive Care Unit], and/or all-cause mortality). The secondary endpoint was incidence of MACE (Major Adverse Cardiovascular Events). We evaluated both outcomes in patients whose treatment with ACEI/ARB continued or was withdrawn during hospitalization.

Results

Between February and June 2020, 11,205 patients were included, with mean age 67 years (SD=16.3) and 43.1% female; 2,162 patients received ACEI/ARB treatment. ACEI/ARB treatment showed a protective effect on all-cause mortality (p<.0001). In hypertensive patients it was also protective in terms of IMV, ICU admission, and the composite outcome of prognosis (p<.0001 for all). No differences were found in incidence of MACE. Patients previously treated with ACEI/ARB who continued treatment during hospitalization had a lower incidence of the composite outcome of prognosis than those whose treatment was withdrawn (RR 0.67, 95%CI 0.63-0.76). ARB had a more beneficial effect on survival than ACEI (HR 0.77, 95%CI 0.62-0.96).

Conclusion

ACEI/ARB treatment during COVID-19 hospitalization had a protective effect on mortality. The benefits were greater in hypertensive patients, those who continued treatment during hospitalization, and those taking ARB.

Summary

Treatment with ACEI/ARB during COVID-19 hospitalization showed a beneficial effect on mortality in the general population. The benefit was greater in hypertensive patients, in those who maintained treatment during hospitalization and those taking ARB.

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