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Observational Study
. 2021 Feb 1:324:249-254.
doi: 10.1016/j.ijcard.2020.09.062. Epub 2020 Sep 25.

The role of anti-hypertensive treatment, comorbidities and early introduction of LMWH in the setting of COVID-19: A retrospective, observational study in Northern Italy

Antonio Desai  1 , Giuseppe Voza  2 , Silvia Paiardi  2 , Francesca Ilaria Teofilo  2 , Giuseppe Caltagirone  3 , Marta Ripoll Pons  2 , Monia Aloise  2 , Maria Kogan  2 , Tobia Tommasini  4 , Victor Savevski  4 , Giulio Stefanini  5 , Claudio Angelini  6 , Michele Ciccarelli  7 , Salvatore Badalamenti  6 , Ana Lleo De Nalda  8 , Alessio Aghemo  8 , Maurizio Cecconi  9 , Filippo Martinelli Boneschi  10 , Antonio Voza  2 ; Humanitas COVID-19 task force
Affiliations
Observational Study

The role of anti-hypertensive treatment, comorbidities and early introduction of LMWH in the setting of COVID-19: A retrospective, observational study in Northern Italy

Antonio Desai et al. Int J Cardiol. .

Abstract

Background: There is a great deal of debate about the role of cardiovascular comorbidities and the chronic use of antihypertensive agents (such as ACE-I and ARBs) on mortality on COVID-19 patients. Of note, ACE2 is responsible for the host cell entry of the virus.

Methods: We extracted data on 575 consecutive patients with laboratory-confirmed SARS-CoV-2 infection admitted to the Emergency Department (ED) of Humanitas Center, between February 21 and April 14, 2020. The aim of the study was to evaluate the role of chronic treatment with ACE-I or ARBs and other clinical predictors on in-hospital mortality in a cohort of COVID-19 patients.

Results: Multivariate analysis showed that a chronic intake of ACE-I was associated with a trend in reduction of mortality (OR: 0.53; 95% CI: 0.27-1.03; p = 0.06), differently from a chronic intake of ARB (OR: 1.1; 95% CI: 0.5-2.8; p=0.8). Increased age (ORs ranging from 3.4 to 25.2 and to 39.5 for 60-70, 70-80 and >80 years vs <60) and cardiovascular comorbidities (OR: 1.90; 95% CI: 1.1-3.3; p = 0.02) were confirmed as important risk factors for COVID-19 mortality. Timely treatment with low-molecular-weight heparin (LMWH) in ED was found to be protective (OR: 0.36; 95% CI: 0.21-0.62; p < 0.0001).

Conclusions: This study can contribute to understand the reasons behind the high mortality rate of patients in Lombardy, a region which accounts for >50% of total Italian deaths. Based on our findings, we support that daily intake of antihypertensive medications in the setting of COVID-19 should not be discontinued and that a timely LMWH administration in ED has shown to decrease in-hospital mortality.

Keywords: ACE-I; ARBs; Cardiovascular; Epidemiology; Hypertension; RAAS.

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Conflict of interest statement

Declaration of Competing Interest None.

Figures

Fig. 1
Fig. 1
Forest plot of predictors of in-hospital mortality at univariate logistic regression analysis. X axis was treated in a logarithmic scale.
Fig. 2
Fig. 2
Forest plot of predictors of in-hospital mortality at multivariate logistic regression analysis. X axis was treated in a logarithmic scale.
See this image and copyright information in PMC

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