Patients with hypertension hospitalized with COVID-19 pneumonia using angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers or other antihypertensives: retrospective analysis of 435 patients

BACKGROUND: The angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARBs) are widely used for the treatment of hypertension (HT). Whether the use of these drugs increases the infectivity of novel coronavirus and results in an additional risk for morbidity and mortality of COVID-19 is a matter of interest. OBJECTIVES: Assess the effect of ACEI/ARBs compared with other hypertensives on the clinical course and outcome in COVID-19 pneumonia. DESIGN: Retrospective. SETTINGS: Tertiary care hospital. PATIENTS AND METHODS: We collected data on adult inpatients with COVID-19 pneumonia using ACEI/ARBs versus other antihypertensives between 15 March 2020, and 15 February 2021. MAIN OUTCOME MEASURES: Severity, clinical course, mortality, and time to PCR negativity between patients using ACEI/ARBs and other antihypertensives. SAMPLE SIZE: 435. RESULTS: ACEI/ARBs were used by 203 patients (46.6%) (median age: 71 [41-94] years), while 232 patients (53.4%) were using other antihypertensives (median age: 69 [22-93] years, P=.645 vs age of ACEI/ARB users). There were no statistically significant differences between the ACEI/ARBs users and non-users in the number of patients admitted to intensive care (65 cases [32%] vs. 74 cases [31.9%], P=.978), the median duration of stay in hospital (8 [1-54] days vs. 7 [1-55] days, P=.806) the median duration of ICU stay (8 [1-40] days vs. 6 [1-25] days), and the mortality rate (48 cases [23.6%] vs. 61 [26.3%], P=.525). While the median days before transfer to the ICU was shorter in ACE/ARBI non-users (2 [1-15] days vs. 3 [1-21] days, P=.02), the difference was not important clinically. The median time to PCR negativity was similar in ACEI/ARBs users and nonusers (13 [7-34] days for users and 13 [5-45] days for non-users), (P=.083). CONCLUSIONS: ACEI/ARB use is probably unrelated to poor prognosis in COVID-19 pneumonia inpatients. ACEI/ARBs did not prolong the time to PCR negativity. We conclude that using ACEI/ARBs probably does not increase the infectivity of SARS-CoV-2. LIMITATIONS: Pharmacological therapies were not discussed in detail. The use of corticosteroids may affect the time to PCR negativity. We could not analyze the effect of obesity because of a lack of data.