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Observational Study
. 2021 Feb;74(2):175-182.
doi: 10.1016/j.rec.2020.05.018. Epub 2020 Jun 5.

Impact of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on COVID-19 in a western population. CARDIOVID registry

[Article in English, Spanish]
Diego López-Otero  1 , Javier López-Pais  2 , Carla Eugenia Cacho-Antonio  3 , Pablo José Antúnez-Muiños  3 , Teba González-Ferrero  3 , Marta Pérez-Poza  3 , Óscar Otero-García  3 , Brais Díaz-Fernández  2 , María Bastos-Fernández  2 , Noelia Bouzas-Cruz  4 , Xoan Carlos Sanmartín-Pena  2 , Alfonso Varela-Román  2 , Manuel Portela-Romero  5 , Luis Valdés-Cuadrado  6 , Antonio Pose-Reino  7 , José Ramón González-Juanatey  2
Affiliations
Observational Study

Impact of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on COVID-19 in a western population. CARDIOVID registry

[Article in English, Spanish]
Diego López-Otero et al. Rev Esp Cardiol (Engl Ed). 2021 Feb.

Abstract
in English, Spanish

Introduction and objectives: Coronavirus disease (COVID-19) has been designated a global pandemic by the World Health Organization. It is unclear whether previous treatment with angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) affects the prognosis of COVID-19 patients. The aim of this study was to evaluate the clinical implications of previous treatment with ACEI/ARB on the prognosis of patients with COVID-19 infection.

Methods: Single-center, retrospective, observational cohort study based on all the inhabitants of our health area. Analyses of main outcomes (mortality, heart failure, hospitalization, intensive care unit [ICU] admission, and major acute cardiovascular events [a composite of mortality and heart failure]) were adjusted by multivariate logistic regression and propensity score matching models.

Results: Of the total population, 447 979 inhabitants, 965 patients (0.22%) were diagnosed with COVID-19 infection, and 210 (21.8%) were under ACEI or ARB treatment at the time of diagnosis. Treatment with ACEI/ARB (combined and individually) had no effect on mortality (OR, 0.62; 95%CI, 0.17-2.26; P=.486), heart failure (OR, 1.37; 95%CI, 0.39-4.77; P=.622), hospitalization rate (OR, 0.85; 95%CI, 0.45-1.64; P=.638), ICU admission (OR, 0.87; 95%CI, 0.30-2.50; P=.798), or major acute cardiovascular events (OR, 1.06; 95%CI, 0.39-2.83; P=.915). This neutral effect remained in a subgroup analysis of patients requiring hospitalization.

Conclusions: Previous treatment with ACEI/ARB in patients with COVID-19 had no effect on mortality, heart failure, requirement for hospitalization, or ICU admission. Withdrawal of ACEI/ARB in patients testing positive for COVID-19 would not be justified, in line with current recommendations of scientific societies and government agencies.

Introducción y objetivos: La Organización Mundial de la Salud calificó la enfermedad de coronavirus (COVID-19) como una pandemia global. No está claro si el tratamiento previo con inhibidores de la enzima de conversión de la angiotensina (IECA) y antagonistas de los receptores de angiotensina (ARA-II) tiene un impacto en el pronóstico de los pacientes infectados con COVID-19. El objetivo fue evaluar la implicación clínica del tratamiento previo con IECA/ARA-II en el pronóstico de la COVID-19.

Métodos: Estudio observacional, retrospectivo, unicéntrico, de cohortes basado en todos los habitantes del área de salud. El análisis de los resultados principales (mortalidad, insuficiencia cardiaca, hospitalización, ingreso en la unidad de cuidados intensivos (UCI) y eventos cardiovasculares agudos mayores [un compuesto de mortalidad e insuficiencia cardiaca]), se ajustó mediante modelos de regresión logística multivariada y modelos de coincidencia de puntaje de propensión.

Resultados: De una población total, 447.979 habitantes, 965 pacientes (0,22%), fueron diagnosticados de infección por COVID-19, 210 (21,8%) estaban bajo tratamiento con IECA o ARA-II en el momento del diagnóstico. El tratamiento con IECA/ARA-II (combinado e individualmente) no tuvo efecto sobre la mortalidad (OR = 0,62; IC95%, 0,17-2,26; p = 0,486), insuficiencia cardiaca (OR = 1,37; IC95%, 0,39-4,77; p = 0,622), tasa de hospitalización (OR = 0,85; IC95%, 0,45-1,64; p = 0,638), ingreso en UCI (OR = 0,87; IC95%, 0,30-2,50; p = 0,798) y cardiopatía aguda grave eventos (OR = 1,06; IC95%, 0,39-2,83; p = 0,915). En el análisis del subgrupos de pacientes que requirieron hospitalización, el efecto se mantuvo neutral.

Conclusiones: El tratamiento previo con IECA/ARA-II en pacientes con COVID-19 no tuvo efecto sobre la mortalidad, la aparición de insuficiencia cardíaca, ni en la necesidad de hospitalización ni ingreso en UCI. La supresión de IECA/ARA-II en pacientes con COVID-19 no estaría justificada en ningún caso, de acuerdo a las recomendaciones actuales de las sociedades científicas y las agencias gubernamentales.

Keywords: Angiotensin receptor blockers; Angiotensin-converting enzyme inhibitors; Antagonistas del receptor de la angiotensina II; COVID-19; Inhibidores de la enzima de conversión de la angiotensina.

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Figures

Figure 1
Figure 1
Events in the COVID-19 positive cohort depending on the type of treatment. ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers.
Figure 2
Figure 2
Events in the COVID-19 hospitalized cohort depending on the type of treatment. ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers.
Figure 3
Figure 3
Hospital admissions according to type of treatment. ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers; ICU, intensive care unit.
See this image and copyright information in PMC

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