The Association of Renin-Angiotensin-Aldosterone System Inhibitors With Outcomes Among a Predominantly Ethnic Minority Patient Population Hospitalized With COVID-19: The Bronx Experience

Abstract

Background and objective Angiotensin-converting enzyme inhibitors (ACE) and angiotensin II receptor blockers (ARB) are commonly used for the treatment of patients with heart disease, hypertension (HTN), and diabetes mellitus (DM). In the aftermath of the emergence of the coronavirus disease 2019 (COVID-19) pandemic, initial data raised concerns that ACE/ARB use can increase the expression of ACE2 receptors, leading to the worsening of COVID-19. However, recent studies have suggested that their use might be safe in a select subgroup of patients. We conducted a single-center retrospective study to evaluate the association of in-patient use of ACE/ARB with outcomes among a predominantly ethnic minority patient population of the inner New York City (NYC). Methods This was a retrospective analysis of all hospital admissions with COVID-19 from March 1, 2020, to March 31, 2020. Results Of the 469 patients included in the study, 91 patients (19.4%) used ACE/ARB therapy during their hospital stay and were labeled as ACE/ARB group. Patients in the ACE/ARB therapy group were older and had a higher incidence of HTN, coronary artery disease (CAD), congestive heart failure, DM, asthma, and chronic obstructive pulmonary disease. Admission D-dimer, lactate dehydrogenase (LDH), and C-reactive protein (CRP) levels were similar between the two groups, but absolute lymphocyte count (ALC) was lower in the non-ACE/ARB group (0.971 k/ul vs. 1.135 k/ul, p=0.0144). The incidence of hyperkalemia and the rise in creatinine were similar between the two groups. Univariate analysis by treatment group using the log-rank test produced significant results (p=0.0062), indicating a higher survival rate for the ACE/ARB group. Conclusion The use of ACE/ARB appears to be safe in all patients in whom their use is medically indicated.

Keywords: angiotensin ii receptor blockers; angiotension converting enzymes inhibitors; coronavirus disease 2019.

Figure 1. Univariate analysis by treatment group using log-rank test

The chart indicates a higher survival rate for ACE/ARB group (denoted T) compared to the non-ACE/ARB group (denoted C) ACE: angiotensin-converting enzyme inhibitors; ARB: angiotensin II receptor blockers

Figure 2. Kaplan-Meier estimates for the survival curve for the smoking history variable

[Red line (T) denotes smokers, blue lines (C) denotes non-smokers]

Figure 3. Receiver operator curve for the final logistic model