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. 2021 Jun 15;10(12):2642.
doi: 10.3390/jcm10122642.

Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Withdrawal Is Associated with Higher Mortality in Hospitalized Patients with COVID-19

Emilia Roy-Vallejo  1 , Aquilino Sánchez Purificación  2 , José David Torres Peña  3   4 , Beatriz Sánchez Moreno  1 , Francisco Arnalich  2 , María José García Blanco  1 , José López Miranda  3   4 , Juan Luis Romero-Cabrera  3   4 , Carmen Rosario Herrero Gil  2 , José Bascunana  5 , Manuel Rubio-Rivas  6 , Sara Pintos Otero  7 , Verónica Martínez Sempere  8 , Jesús Ballano Rodríguez-Solís  9 , Ricardo Gil Sánchez  10 , Jairo Luque Del Pino  11 , Amara González Noya  12 , María Sierra Navas-Alcántara  13 , Begoña Cortés Rodríguez  14 , José Nicolás Alcalá  15 , Ana Suárez-Lombraña  16 , Jorge Andrés Soler  17 , Ricardo Gómez-Huelgas  18 , José Manuel Casas-Rojo  19 , Jesús Millán Núñez-Cortés  20 , On Behalf Of The Semi-Covid-Network
Affiliations

Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Withdrawal Is Associated with Higher Mortality in Hospitalized Patients with COVID-19

Emilia Roy-Vallejo et al. J Clin Med. .

Abstract

Our main aim was to describe the effect on the severity of ACEI (angiotensin-converting enzyme inhibitor) and ARB (angiotensin II receptor blocker) during COVID-19 hospitalization. A retrospective, observational, multicenter study evaluating hospitalized patients with COVID-19 treated with ACEI/ARB. The primary endpoint was the incidence of the composite outcome of prognosis (IMV (invasive mechanical ventilation), NIMV (non-invasive mechanical ventilation), ICU admission (intensive care unit), and/or all-cause mortality). We evaluated both outcomes in patients whose treatment with ACEI/ARB was continued or withdrawn. Between February and June 2020, 11,205 patients were included, mean age 67 years (SD = 16.3) and 43.1% female; 2162 patients received ACEI/ARB treatment. ACEI/ARB treatment showed lower all-cause mortality (p < 0.0001). Hypertensive patients in the ACEI/ARB group had better results in IMV, ICU admission, and the composite outcome of prognosis (p < 0.0001 for all). No differences were found in the incidence of major adverse cardiovascular events. Patients previously treated with ACEI/ARB continuing treatment during hospitalization had a lower incidence of the composite outcome of prognosis than those whose treatment was withdrawn (RR 0.67, 95%CI 0.63-0.76). ARB was associated with better survival than ACEI (HR 0.77, 95%CI 0.62-0.96). ACEI/ARB treatment during COVID-19 hospitalization was associated with protection on mortality. The benefits were greater in hypertensive, those who continued treatment, and those taking ARB.

Keywords: ACEI; ARB; COVID-19; MACE; prognosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient inclusion flowchart. RT-PCR: real-time polymerase chain reaction, ACEI: angiotensin-converting enzyme inhibitor, ARB: angiotensin II receptor blocker.
Figure 2
Figure 2
Effect on survival of treatment with ACEI/ARB during hospitalization. (A) Kaplan–Meier survival analysis for normotensive patients; (B) Kaplan–Meier survival analysis for hypertensive patients. Treatment with ACEI/ARB in solid lines; non-ACEI/ARB group in dotted lines. ACEI/ARBACEI: Angiotensin-Converting Enzyme Inhibitor. ARB: Angiotensin Receptor Blocker. Statistical significance was determined with a log-rank test.
Figure 2
Figure 2
Effect on survival of treatment with ACEI/ARB during hospitalization. (A) Kaplan–Meier survival analysis for normotensive patients; (B) Kaplan–Meier survival analysis for hypertensive patients. Treatment with ACEI/ARB in solid lines; non-ACEI/ARB group in dotted lines. ACEI/ARBACEI: Angiotensin-Converting Enzyme Inhibitor. ARB: Angiotensin Receptor Blocker. Statistical significance was determined with a log-rank test.
Figure 3
Figure 3
Effect on survival of discontinuation vs. continuation of ACEI/ARB treatment during hospitalization. Kaplan–Meier survival analysis comparing continuation of ACEI/ARB (solid lines) with its withdrawing (dotted lines). ACEI: angiotensin-converting enzyme inhibitor. ARB: angiotensin receptor blocker. Statistical significance was determined with a log-rank test.
See this image and copyright information in PMC

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