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

Roy-Vallejo, Emilia; Sánchez Purificación, Aquilino; Torres Peña, José David; Sánchez Moreno, Beatriz; Arnalich, Francisco; García Blanco, María José; López Miranda, José; Romero-Cabrera, Juan Luis; Herrero Gil, Carmen Rosario; Bascunana, José; Rubio-Rivas, Manuel; Pintos Otero, Sara; Martínez Sempere, Verónica; Ballano Rodríguez-Solís, Jesús; Gil Sánchez, Ricardo; Luque del Pino, Jairo; González Noya, Amara; Navas-Alcántara, María Sierra; Cortés Rodríguez, Begoña; Alcalá, José Nicolás; Suárez-Lombraña, Ana; Andrés Soler, Jorge; Gómez-Huelgas, Ricardo; Casas-Rojo, José Manuel; Millán Núñez-Cortés, Jesús

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 We evaluated both outcomes in patients whose treatment with ACEI/ARB was continued or withdrawn.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during hospitalization had a lower incidence of the composite outcome of prognosis than those whose treatment was withdrawn (RR 0.67, 95%CI 0.63–0.76).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.