Association Between COVID-19 Mortality and ICU Admission Rates and Prior History of Angiotensin-Converting Enzyme or Angiotensin Receptor Blockers Use Among Hospitalized COVID-19 Patients with Hypertension in Michigan. (preprint)

ABSTRACT

Abstract Importance There are conflicting data regarding the safety of the use of Angiotensin-converting enzyme inhibitors or Angiotensin receptor blockers (ACEI/ARBs ) medications in hypertensive patients who are susceptible to COVID-19. Objective: Our study assesses the association between COVID-19 severity and mortality and the use of ACEI/ARBs among hospitalized patients with hypertension. Research design, setting and participants: This was a retrospective cohort study. Using the EPIC system of Beaumont Health, we identified 5490 patients with COVID-19 who were admitted to the eight Beaumont hospitals. After excluding subjects who have no hypertension and those with missing data, we included 2129 COVID-19 patients who have hypertension. Logistic regression and Cox proportional hazard models were used to analyze the association history of ACEI/ARBs use, ICU admission rate and COVID-19 mortality. Exposure Using of ACEI/ARBs as documented in the medical records before admission to the hospitals. Main outcome: 30 days COVID-19 mortality and ICU admission rates . Results:  There were 1281 subjects (60%) with prior ACEI/ARBs use and 848 subjects ( 40%) with no ACEI/ARBs use. There was no significant association between ICU admission and use of ACEI/ARBs (odds ratio was 0.95, 95% CI [0.76, 1.19] and p-value was 0.6). Although the unadjusted logistic regression model demonstrated a statistically significant association between history of use of ACEI/ARBs and COVID-19 mortality (odds ratio= 1.31, 95% CI [1.05, 1.66], p-value= 0.02), the adjusted logistic regression model failed to show this statistically significant association (odds ratio= 1.20, 95% CI [0.93, 1.54], p-value= 0.14). Moreover, we were not able to reveal a statistically significant association between 30 days COVID-19 survival and prior use of ACEI/ARBs in the adjusted Cox-proportional hazard model (Hazard ratio (HR) = 1.11, 95% CI [0.91, 1.40], p-value =0.14). Conclusion: In a large retrospective study, we conclude that there was no statistically significant association between prior history of ACEI/ARBs use and COVID-19 ICU admission rates or mortality in hypertensive patients hospitalized with COVID-19.