A study of prognosis and outcome of COVID-19-infected hypertensive patients on angiotensin-converting enzyme inhibitors/angiotensin receptor blockers

Abstract

Background and Objective: COVID-19 is a pandemic caused by the virus severe acute respiratory syndrome coronavirus-2. The mortality in susceptible populations with chronic pulmonary disease, cardiac ailments, kidney disease, diabetes, and hypertension is high. While the role of angiotensin-converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARBs) in contracting novel coronavirus has clearly been elucidated, there remains uncertainty in the prognosis and outcome of COVID-19-infected patients on ACE inhibitors and ARBs. The current study was conducted to find whether these medications bore any significance in the prognosis and outcome of hypertensive patients with COVID-19 infection. Materials and Methods: This is a retrospective cohort study. We studied 96-admitted hypertensive patients with pneumonia due to COVID-19 in Krishna Rajendra Hospital at Mysore during April 2021. Patients were categorized into two groups based on antihypertensive treatment: (1) Those on ACEi/ARBs (n = 33) and (2) Those on non-ACEi/ARBs (n = 66). We analyzed the parameters such as duration of hypertension, comorbidities, mode of oxygen/pressure support delivery, duration of hospital stay, and mortality among the two groups. Results: 65.6% of patients were on non-ACEi/ARBs, 10.4% on ACE inhibitors, and 24% on ARBs. Of the patients on non-ACEi/non-ARBs, 51% were on supplemental oxygen, 20.8% were on NIV, 6.3% were intubated, and 21.9% did not require oxygen. Of those on ACEi, 63.6% were on supplemental oxygen, 15.2% were on NIV, none were intubated, and 21.2% did not require oxygen. Of those on ARBs, 53.3% were on supplemental oxygen, 18.5% were on NIV, 5.4% were intubated, and 22.8% did not require oxygen. 62.5% of patients on non-ACEi/ARBs recovered, whereas 37.5% succumbed. 83.3% of patients on ACEi recovered, whereas 16.7% succumbed. 65.2% of patients on ARBs recovered, whereas 34.8% succumbed. There was no significant correlation between non-ACEi/ARBs, ACEi, and ARBs with duration of hypertension (P = 0.092), sex (P = 0.189), mode of oxygen/pressure support delivery (P = 0.313), ward/intensive care unit stay (P = 0.624), and the final outcome of the patient (P = 0.734). Conclusion: In the population studied, the use of ACEi/ARBs in COVID-positive hypertensives was not associated with adverse outcomes as compared to those on non-ACEi/non-ARBs.

Keywords

• angiotensin-converting enzyme inhibitors/angiotensin receptor blockers
• covid-19
• hypertension