Prediction of mortality in hypertensive covid-19 patients receiving renin angiotensin aldosterone-based therapy: An evidence-based case report

ABSTRACT

Hypertension is the most common comorbidity found in COVID-19 patients, which might increase the risk of mortality. Inhibitors of the RAAS are among the first-choice agents in hypertension, including ACE-I and ARB. The use of RAAS inhibitors is thought to increase the expression of ACE-2 receptors, facilitating the entry of SARS-CoV-2, which might result in increased mortality, though previous studies got conflicting results. This evidence-based case report was made to answer whether the use of RAAS inhibitors increases the mortality in COVID-19 patients. We explored studies relevant to our clinical question, including only systematic reviews, meta-analyses, and cohort studies that compared mortality rate in hypertensive COVID-19 patients receiving RAAS inhibitors to those who were not. Articles were then selected by title and abstract screening and elimination of articles that did not fit our clinical question and eligibility criteria. The result of selected papers was then critically appraised according to the validity, importance, and applicability of the studies using the critical appraisal form from CEBM. From 191 articles initially found, three studies fit our eligibility criteria (1 systematic review, evidence level 2A, and two cohort studies, evidence level 2B). The systematic review shows an OR of 0.73 ((95% CI 0,56-0,95;p = 0.001) with substantial heterogeneity (I2=74%). The first cohort study shows an HR of 0,97 (95% CI 0,89-1,06) in patients receiving ACE-I and HR of 0,98 (95% CI 0,89-1,06) in patients receiving ARB compared to those who received CCB. The second cohort study shows an OR of OR 0.623 (95% CI 0.423-0.917;p = 0,016). Findings gathered from various studies showed inconclusive results regarding the use of RAAS inhibitors in hypertensive COVID-19 patients. From our critical appraisal, we found that RAAS inhibitors’ usage tends not to increase the mortality of COVID-19 patients. Thus, we suggest that COVID-19 patients on RAAS inhibitors should continue with their treatment regimen. A large-scale cohort study is still needed to get a conclusion with more robust evidence.