Clinical Outcomes From COVID-19 Following Use of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers Among Patients with Hypertension in South Korea: A nationwide study

Kim, J. H.; Baek, Y.-H.; Lee, H.; Choe, Y. J.; Shin, H. J.; Shin, J.-Y.

There is ongoing debate as to whether angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) use is associated with poor prognosis of coronavirus disease-2019 (COVID-19). We sought to investigate the association between ACEI/ARB use and risk of poor clinical outcomes from COVID-19. We identified 1,290 patients with hypertension, of which 682 had recorded ACEI/ARB use and 608 without the use during 30 days preceding the date of COVID-19 diagnosis in completely enumerated COVID-19 cohort in South Korea. Our primary endpoint was the clinical outcomes comprised of all-cause mortality, use of mechanical ventilation, intensive care unit (ICU) admission, and sepsis. We used inverse probability of treatment weighting (IPTW) to mitigate selection bias, and Poisson regression model to estimate the relative risks (RR) and 95% confidence intervals (CI) to compare outcomes in ACEI/ARB users with non-users. Compared to non-use, ACEI/ARB use was associated with lower clinical outcomes (IPTW adjusted RR, 0.60; 95% CI, 0.42-0.85; p=0.0046). When assessed by individual outcomes, ACEI/ARB use was not associated with all-cause mortality (IPTW adjusted RR, 0.62; 95% CI, 0.35-1.09; p=0.0973) and respiratory events (IPTW adjusted RR, 0.99; 95% CI, 0.84-1.17; p=0.9043). Subgroup analysis showed a trend toward protective role of ACEIs and ARBs against overall outcomes in men (IPTW adjusted RR, 0.84; 95% CI, 0.69-1.03; p-for-interaction=0.008) and with pre-existing respiratory disease (IPTW adjusted RR, 0.74; 95% CI, 0.60-0.92; p-for-interaction=0.0023). We present clinical evidence to support continuing ACE/ARB use in completely enumerated hypertensive COVID-19 cohort in South Korea.