ABSTRACT
Objective: The link with angiotensin-converting-enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) is because of the known association between angiotensin-converting enzyme 2 (ACE) and SARS-COV 2. ACE 2 has been shown to be a co-receptor for viral entry for SARS-COV-2 in the respiratory epithelium. It has been a global concern that the use of this drugs may be a risk for patients with COVID-19 infection. It has been published many studies about this subject. Even today there are still controversies regarding to the impact of these drugs. The aim of this study was to determine the association between the previous use of ACEI/ARB and the prognosis of patients with COVID-19 infection Design and method: Single-center, restrospective, cohort study included 608 patients with hypertension diagnosed with COVID-19, who where hospitalized in Macarena's hospital from Mars to December 2020. Analyses of main outcomes (mortality, need of intensive cares (ICU), and days of mean study) were adjusted by multivariate logistic regression. Results: Of a total population of 500,000, 608 patients (0.12%) required admission for COVID-19. A total of 83.7% were hypertensive, specifically 75.9% were under antihypertensive treatment (35.7% with only 1 drug, 29.9% were taking two drugs, 9% with three drugs, and 1.3% with 4 drugs). 26.2% were treated with an ACEI and 24.8% with ARBs. Treatment with ACEI / ARB-II (combined or individually) had no impact on mortality (OR = 1.29;95% CI, 0.829-2.014;p = 0.257), nor ICU admission (OR = 1, 7;95% CI, 0.68 - 4.95;p = 0.232), nor on the days of mean stay (OR = 0.98;95% CI, 0.95-1.04;p = 0.325). Conclusions: It is unlikely that previous treatment with ACEI/ARB was associated with an increased mortality risk, neither ICU admission or an increase in days of mean stay. This study supports current guidelines that discourage discontinuation of ACEIS or ARBs in COVID-19 patients.
ABSTRACT
Objective: Hypertension is one of the most important factors for cardiovascular disease. It has been repeatedly proposed as a prognostic factor of severe COVID- 19 and has been included in clinical risk scores to predict the occurrence of critical illness in ospitalised with COVID-19. Also, it has been postulated the relation between antihypertensive drugs and the severity of COVID-19. The aims of our study were to analyze whether hypertension and antihypertensive treatment represent an independent risk factor for death or intensive care unit admission in patients with SARS-COV2. Design and method: Observational, retrospective, single-center cohort study of all patients admitted to Hospital Virgen Macarena diagnosed with COVID-19 between the months of March and December 2020. A bivariate analysis was performed using Pearson's chi-square Results: 608 patients required admission for COVID-19. A total of 83.7% were hypertensive, specifically 75.9% were under antihypertensive treatment (35.7% with only 1 drug, 29.9% were taking two drugs, 9% with three drugs, and 1.3% with 4 drugs). 26.2% were treated with an ACEI, 24.8% with ARA-II, 16.8% with calcium-antagonists, 30.9% with diuretics, 21.2% with beta-blockers, 0, 5% with alpha-blockers). Hypertension did not show a statistically significant relationship with mortality (p = 0.34), increase in mortality and ICU admissions. Neither treatment with ACEI (p = 0.4), ARB-II (p = 0.45), calcium antagonists (p = 0.53), diuretics (p = 0.68), alpha blockers (p = 0.07) demonstrated relation with those items. Surprisingly, beta-blockers increased the mortality in patients with SARS-COV2 (p = 0.048). Probably this results can be explained as these drugs were indicated for rate control in patients with atrial fibrillation (p = 0.006). The number of antihypertensive drugs used also did not show a statistically significant relationship with an increase in mortality (p = 0.978). Conclusions: Hypertension is a highly prevalent pathology in patients ospitalised with COVID-19 infection. However, high blood pressure was not associated with a higher risk for mortality in patients with SARS-COV-2, neither the type or the number of antihypertensive drug used. Only beta-blockers alter outcomes in hypertensive patients with COVID-19, as they were associated with more deaths.