Chronic Use Of Renin-Angiotensin-Aldosterone Inhibitors In Hypertensive Covid-19 Patients: Results From A Spanish Registry And Meta-Analysis

Aparisi, Álvaro; Catalá, Pablo; Amat-Santos, Ignacio J; Marcos, Marta; López-Otero, Diego; Veras, Carlos; López-Pais, Javier; Cabezón, Gonzalo; Antonio, Carla Eugenia Cacho; Candela, Jordi; Antúnez-Muiños, Pablo; Francisco-Gil, José; Ferrero, Teba González; Rojas, Gino; Pérez-Poza, Marta; Uribarri, Aitor; Otero-García, Oscar; García-Granja, Pablo Elpidio; Ramos, Víctor Jiménez; Revilla, Ana; Dueñas, Carlos; Gómez, Itzíar; Ramón González-Juanatey, José; Alberto San Román, J

Background: Hypertension is a prevalent condition among SARS-CoV-2 infected patients. Whether renin-angiotensin-aldosterone system (RAAS) inhibitors are beneficial or harmful is controversial. Methods: We have performed a national retrospective, nonexperimental comparative study from two tertiary hospitals to evaluate the impact of chronic use of RAAS inhibitors in hypertensive COVID-19 patients. A meta-analysis was performed to strengthen our findings. Results: Of 849 patients, 422 (49.7%) patients were hypertensive and 310 (73.5%) were taking RAAS inhibitors at baseline. Hypertensive patients were older, had more comorbidities, and a greater incidence of respiratory failure (-0.151 [95% CI -0.218, -0.084]). Overall mortality in hypertensive patients was 28.4%, but smaller among those with prescribed RAAS inhibitors before (-0.167 [95% CI -0.220, -0.114]) and during hospitalization (0.090 [-0.008,0.188]). Similar findings were observed after two propensity score matches that evaluated the benefit of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers among hypertensive patients. Multivariate logistic regression analysis of hypertensive patients found that age, diabetes mellitus, C-reactive protein, and renal failure were independently associated with all-cause mortality. On the contrary, ACEIs decreased the risk of death (OR 0.444 [95% CI 0.224-0.881]). Meta-analysis suggested a protective benefit of RAAS inhibitors (OR 0.6 [95% CI 0.42-0.8]) among hypertensive COVID-19. Conclusion: Our data suggest that RAAS inhibitors may play a protective role in hypertensive COVID-19 patients. This finding was supported by a meta-analysis of the current evidence. Maintaining these medications during hospital stay may not negatively affect COVID-19 outcomes.