Continued in-hospital angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker use in hypertensive COVID-19 patients is associated with positive clinical outcome

Katherine W. Lam, Kenneth W. Chow, Jonathan Vo, Wei Hou, Haifang Li, Paul S. Richman, Sandeep K. Mallipattu, Hal A. Skopicki, Adam J. Singer, Tim Q. Duong

Research output: Contribution to journalArticlepeer-review

37 Scopus citations

Abstract

Background. This study investigated continued and discontinued use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB) during hospitalization of 614 hypertensive laboratory-confirmed COVID-19 patients. Methods. Demographics, comorbidities, vital signs, laboratory data, and ACEi/ARB usage were analyzed. To account for confounders, patients were substratified by whether they developed hypotension and acute kidney injury (AKI) during the index hospitalization. Results. Mortality (22% vs 17%, P >.05) and intensive care unit (ICU) admission (26% vs 12%, P >.05) rates were not significantly different between non-ACEi/ARB and ACEi/ARB groups. However, patients who continued ACEi/ARBs in the hospital had a markedly lower ICU admission rate (12% vs 26%; P =.001; odds ratio [OR] = 0.347; 95% confidence interval [CI],.187-.643) and mortality rate (6% vs 28%; P =.001; OR = 0.215; 95% CI,.101-.455) compared to patients who discontinued ACEi/ARB. The odds ratio for mortality remained significantly lower after accounting for development of hypotension or AKI. Conclusions. These findings suggest that continued ACEi/ARB use in hypertensive COVID-19 patients yields better clinical outcomes.

Original languageEnglish (US)
Pages (from-to)1256-1264
Number of pages9
JournalJournal of Infectious Diseases
Volume222
Issue number8
DOIs
StatePublished - Oct 15 2020
Externally publishedYes

Keywords

  • Acute kidney injury
  • Angiotensin II receptor blockers
  • Angiotensin-converting enzyme inhibitors
  • Hypotension
  • Troponin

ASJC Scopus subject areas

  • Immunology and Allergy
  • Infectious Diseases

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