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Effects of Recent Use of Renin-Angiotensin System Inhibitors on Mortality of Patients With Coronavirus Disease 2019.

ABSTRACT: Background:There is growing concern about the potential harmful effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in patients with coronavirus disease 2019 (COVID-19) and cardiovascular diseases (CVDs). The aim of this study was to evaluate the association between recent exposure to ACEIs/ARBs and in-hospital mortality in patients with COVID-19. Methods:We used data from a nationwide cohort of patients with COVID-19 from the health insurance claims data of South Korea, which were released for research purposes for public health by the Ministry of Health and Welfare of South Korea. Patients with COVID-19 were identified using the relevant diagnostic code. Propensity score matching (1:1) was carried out among patients with CVD according to the type of medication (ACEIs/ARBs vs other), and the risk of death was assessed. Results:A total of 4936 patients with COVID-19 were analyzed, of whom 1048 (21.2%) had CVD. Of the 1048 patients with CVD, 864 (82.4%) received at least 1 antihypertensive medication before the diagnosis of COVID-19, including 359 (41.6%) who received ACEIs/ARBs and 505 (58.4%) who received drugs other than ACEIs/ARBs. Using the propensity scores for ACEI/ARB use, we matched 305 pairs of patients receiving ACEIs/ARBs and patients receiving other drugs. Recent use of ACEIs/ARBs was not significantly associated with in-hospital mortality in unadjusted analysis (odds ratio [OR], 0.62; 95% CI, 0.33-1.14) or propensity score matching analysis (OR, 1.00; 95% CI, 0.46-2.16). Conclusions:In patients with COVID-19 and underlying CVDs, the recent use of ACEIs/ARBs was not significantly associated with in-hospital mortality. These findings do not support stopping or modifying ACEIs/ARBs in patients during the current COVID-19 pandemic.

SUBMITTER: Bae S

PROVIDER: S-EPMC7665750 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Effects of Recent Use of Renin-Angiotensin System Inhibitors on Mortality of Patients With Coronavirus Disease 2019.

Bae Seongman S Kim Ju Hyeon JH Kim Ye-Jee YJ Lim Joon Seo JS Yun Sung-Cheol SC Kim Young-Hak YH Lee Sang-Oh SO Kim Sung-Han SH

Open forum infectious diseases 20201027 11

<h4>Background</h4>There is growing concern about the potential harmful effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in patients with coronavirus disease 2019 (COVID-19) and cardiovascular diseases (CVDs). The aim of this study was to evaluate the association between recent exposure to ACEIs/ARBs and in-hospital mortality in patients with COVID-19.<h4>Methods</h4>We used data from a nationwide cohort of patients with COVID-19 from the he ...[more]

PMID: 33235892

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Project description:BackgroundThe effect of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) on mortality was preliminarily explored through the comparison of ACEIs/ARBs with non-ACEIs/ARBs in patients with coronavirus disease 2019 (COVID-19). Reaching a conclusion on whether previous ACEI/ARB treatment should be continued in view of the different ACE2 levels in the comparison groups was not unimpeachable. Therefore, this study aimed to further elucidate the effect of ACEI/ARB continuation on hospital mortality, intensive care unit (ICU) admission, and invasive mechanical ventilation (IMV) in the same patient population.MethodsWe searched PubMed, the Cochrane Library, Ovid, and Embase for relevant articles published between December 1, 2019 and April 30, 2022. Continuation of ACEI/ARB use after hospitalization due to COVID-19 was considered as an exposure and discontinuation of ACEI/ARB considered as a control. The primary outcome was hospital mortality, and the secondary outcomes included 30-day mortality, rate of ICU admission, IMV, and other clinical outcomes.ResultsSeven observational studies and four randomized controlled trials involving 2823 patients were included. The pooled hospital mortality in the continuation group (13.04%, 158/1212) was significantly lower than that (22.15%, 278/1255) in the discontinuation group (risk ratio [RR] = 0.45; 95% confidence interval [CI], 0.28-0.72; P = 0.001). Continuation of ACEI/ARB use was associated with lower rates of ICU admission (10.5% versus 16.2%, RR = 0.63; 95% CI 0.5-0.79; P < 0.0001) and IMV (8.2% versus 12.5%, RR = 0.62; 95% CI 0.46-0.83, P = 0.001). Nevertheless, the effect was mainly demonstrated in the observational study subgroup (P < 0.05). Continuing ACEI/ARB had no significant effect on 30-day mortality (P = 0.34), acute myocardial infarction (P = 0.08), heart failure (P = 0.82), and acute kidney injury after hospitalization (P = 0.98).ConclusionPrevious ACEI/ARB treatment could be continued since it was associated with lower hospital deaths, ICU admission, and IMV in patients with COVID-19, although the benefits of continuing use were mainly shown in observational studies. More evidence from multicenter RCTs are still needed to increase the robustness of the data. Trial registration PROSPERO (CRD42022341169). Registered 27 June 2022.

Dataset Information

Effects of Recent Use of Renin-Angiotensin System Inhibitors on Mortality of Patients With Coronavirus Disease 2019.

Publications

Effects of Recent Use of Renin-Angiotensin System Inhibitors on Mortality of Patients With Coronavirus Disease 2019.

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