Mortality and Pre‐Hospitalization Use of Renin‐Angiotensin System Inhibitors in Patients with Hypertension and Coronavirus Disease 2019 (COVID‐19)

Abstract

Background There has been significant controversy about the effects of pre‐hospitalization use of renin‐angiotensin system (RAS) inhibitors on the prognosis of patients with hypertension and coronavirus disease 2019. Methods and Results We retrospectively assessed 2297 hospitalized patients with coronavirus disease 2019 at Tongji Hospital in Wuhan, China, from January 10 to March 30, 2020; and identified 1182 patients with known hypertension on pre‐hospitalization therapy. We compared the baseline characteristics and in‐hospital mortality between patients with hypertension taking RAS inhibitors (n=355) versus non‐RAS inhibitors (n=827). Of the 1182 patients with hypertension (median age 68 years, 49.1% male), 12/355 (3.4%) patients died in the RAS inhibitors group versus 95/827 (11.5%) patients in the non‐RAS inhibitors group (P<0.0001). Adjusted hazard ratio for mortality was 0.28 (95% CI 0.15–0.52, P<0.0001) at 45 days in the RAS inhibitors group compared with non‐RAS inhibitors group. Similar findings were observed when patients taking angiotensin receptor blockers (n=289) or angiotensin‐converting enzyme inhibitors (n=66) were separately compared with non‐RAS inhibitors group. The RAS inhibitors group compared with non‐RAS inhibitors group had lower levels of C‐reactive protein (median 13.5 versus 24.4 pg/mL; P=0.007) and interleukin‐6 (median 6.0 versus 8.5 pg/mL; P=0.026) on admission. The protective effect of RAS inhibitors on mortality was confirmed in a meta‐analysis of published data when our data were added to previous studies (odd ratio 0.44, 95% CI 0.29–0.65, P<0.0001). Conclusions In a large single center retrospective analysis, we observed a protective effect of pre‐hospitalization use of RAS inhibitors on mortality in patients with hypertension and coronavirus disease 2019, which might be associated with reduced inflammatory response.

Keywords

• angiotensin‐converting enzyme inhibitors
• angiotensin‐converting enzyme‐2
• angiotensin receptor blockers
• COVID‐19
• severe acute respiratory syndrome coronavirus‐2