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Chronic use of renin-angiotensin-aldosterone inhibitors in hypertensive COVID-19 patients: Results from a Spanish registry and meta-analysis.
Aparisi, Álvaro; Catalá, Pablo; Amat-Santos, Ignacio J; Marcos-Mangas, Marta; López-Otero, Diego; Veras, Carlos; López-Pais, Javier; Cabezón-Villalba, Gonzalo; Cacho Antonio, Carla Eugenia; Candela, Jordi; Antúnez-Muiños, Pablo; Gil, José Francisco; González Ferrero, Teba; Rojas, Gino; Pérez-Poza, Marta; Uribarri, Aitor; Otero-García, Oscar; García-Granja, Pablo Elpidio; Jiménez Ramos, Víctor; Revilla, Ana; Dueñas, Carlos; Gómez, Itzíar; González-Juanatey, José Ramón; San Román, J Alberto.
  • Aparisi Á; Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain. Electronic address: alvaro_aparisi@hotmail.com.
  • Catalá P; Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain.
  • Amat-Santos IJ; Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red - Cardiovascular (CIBERCV), Spain.
  • Marcos-Mangas M; Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain.
  • López-Otero D; Centro de Investigación Biomédica en Red - Cardiovascular (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario, Santiago de Compostela, Spain.
  • Veras C; Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain.
  • López-Pais J; Centro de Investigación Biomédica en Red - Cardiovascular (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario, Santiago de Compostela, Spain.
  • Cabezón-Villalba G; Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain.
  • Cacho Antonio CE; Servicio de Cardiología, Hospital Clínico Universitario, Santiago de Compostela, Spain.
  • Candela J; Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain.
  • Antúnez-Muiños P; Servicio de Cardiología, Hospital Clínico Universitario, Santiago de Compostela, Spain.
  • Gil JF; Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain.
  • González Ferrero T; Servicio de Cardiología, Hospital Clínico Universitario, Santiago de Compostela, Spain.
  • Rojas G; Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain.
  • Pérez-Poza M; Servicio de Cardiología, Hospital Clínico Universitario, Santiago de Compostela, Spain.
  • Uribarri A; Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red - Cardiovascular (CIBERCV), Spain.
  • Otero-García O; Servicio de Cardiología, Hospital Clínico Universitario, Santiago de Compostela, Spain.
  • García-Granja PE; Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red - Cardiovascular (CIBERCV), Spain.
  • Jiménez Ramos V; Servicio de Cardiología, Hospital Clínico Universitario, Santiago de Compostela, Spain.
  • Revilla A; Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red - Cardiovascular (CIBERCV), Spain.
  • Dueñas C; Servicio de Enfermedades Infecciosas, Hospital Clínico Universitario, Valladolid, Spain.
  • Gómez I; Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red - Cardiovascular (CIBERCV), Spain.
  • González-Juanatey JR; Centro de Investigación Biomédica en Red - Cardiovascular (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario, Santiago de Compostela, Spain.
  • San Román JA; Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red - Cardiovascular (CIBERCV), Spain.
Med Clin (Barc) ; 158(7): 315-323, 2022 04 08.
Article in English, Spanish | MEDLINE | ID: covidwho-1258460
ABSTRACT

BACKGROUND:

Hypertension is a prevalent condition among SARS-CoV-2 infected patients. Whether renin-angiotensin-aldosterone system (RAAS) inhibitors are beneficial or harmful is controversial.

METHODS:

We have performed a national retrospective, nonexperimental comparative study from two tertiary hospitals to evaluate the impact of chronic use of RAAS inhibitors in hypertensive COVID-19 patients. A meta-analysis was performed to strengthen our findings.

RESULTS:

Of 849 patients, 422 (49.7%) patients were hypertensive and 310 (73.5%) were taking RAAS inhibitors at baseline. Hypertensive patients were older, had more comorbidities, and a greater incidence of respiratory failure (-0.151 [95% CI -0.218, -0.084]). Overall mortality in hypertensive patients was 28.4%, but smaller among those with prescribed RAAS inhibitors before (-0.167 [95% CI -0.220, -0.114]) and during hospitalization (0.090 [-0.008,0.188]). Similar findings were observed after two propensity score matches that evaluated the benefit of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers among hypertensive patients. Multivariate logistic regression analysis of hypertensive patients found that age, diabetes mellitus, C-reactive protein, and renal failure were independently associated with all-cause mortality. On the contrary, ACEIs decreased the risk of death (OR 0.444 [95% CI 0.224-0.881]). Meta-analysis suggested a protective benefit of RAAS inhibitors (OR 0.6 [95% CI 0.42-0.8]) among hypertensive COVID-19.

CONCLUSION:

Our data suggest that RAAS inhibitors may play a protective role in hypertensive COVID-19 patients. This finding was supported by a meta-analysis of the current evidence. Maintaining these medications during hospital stay may not negatively affect COVID-19 outcomes.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Hypertension Type of study: Experimental Studies / Observational study / Prognostic study / Reviews Topics: Long Covid Limits: Humans Language: English / Spanish Journal: Med Clin (Barc) Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Hypertension Type of study: Experimental Studies / Observational study / Prognostic study / Reviews Topics: Long Covid Limits: Humans Language: English / Spanish Journal: Med Clin (Barc) Year: 2022 Document Type: Article