Use of renin-angiotensin system inhibitors and clinical predictors of COVID-19 severity in a tertiary hospital in the city of Buenos Aires

Information regarding predictors of a worse COVID-19 prognosis in the South American population is scarce. We aimed to determine whether the blockade of the renin-angiotensin system is associated with a worse clinical course of COVID-19, and to evaluate what clinical variables are associated with COVID severity in our population. We included adult subjects with rtPCR-confirmed COVID-19. The use of renin system inhibitors was defined according to its registration in the electronic medical record or the hospital pharmacy registry during the previous three months. Our endpoint was a composite of death or mechanical ventilation requirement. Patients were followed up until discharge or death. A multiple logistic regression model was used to determine the predictors of the composite endpoint. In all, we included 4930 COVID+ patients, the median age was 52 years, and 48.1% were male. The endpoint occurred in 488 patients (9.9%). In adjusted analysis, neither angiotensin converting enzyme inhibitors nor angiotensin receptor blockers were associated with the outcome. Independent predictors of mortality and/or mechanical ventilation requirement were age, male sex, a history of diabetes and/or chronic kidney disease, smoking and dementia. To conclude, renin system inhibitors seem to be unrelated to COVID-19 severity, whereas prognosis is independently associated with age, male sex and comorbidities.

[COVID-19 and its relationship with hypertension and cardiovascular disease]. / COVID-19, hipertensión y enfermedad cardiovascular.

The association between hypertension, diabetes, cardio and cerebrovascular disease and severe and fatal COVID-19, described in different countries, is remarkable. Myocardial damage and myocardial dysfunction are postulated as a possible causal nexus. Frequent findings of elevated troponin levels and electrocardiographic anomalies support this concept. On the other hand, hypotheses in favour and against a deleterious effect of angiotensin converting enzyme inhibitors and angiotensin receptor blockers, a usual treatment for cardiovascular disease, have been raised. There is currently no solid evidence and thus properly designed studies on this subject are urgently needed. In this context, patients with cardiovascular disease should especially avoid being exposed to the virus, should not self-medicate and rapidly seek medical advice should they show symptoms of infection.