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Hypertension, renin-angiotensin-aldosterone-system-blocking agents, and COVID-19

Cited 2 time in Web of Science Cited 3 time in Scopus
Authors

Kang, Si-Hyuck; Lee, Dong-Hoon; Han, Kyung-Do; Jung, Jin-Hyung; Park, Sang-Hyun; Dai, Andrew M.; Wei, Henry G.; Yoon, Chang-Hwan; Youn, Tae-Jin; Chae, In-Ho; Kim, Cheol-Ho

Issue Date
2021-06-01
Publisher
BMC
Citation
Clinical Hypertension. 2021 Jun 01;27(1):11
Keywords
Coronavirus infectionsHypertensionAngiotensin-converting enzyme inhibitorsAngiotensin receptor antagonists
Abstract
Background
There have been concerns regarding the safety of renin-angiotensin-aldosterone-system (RAAS)-blocking agents including angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) during the coronavirus disease 2019 (COVID-19) pandemic. This study sought to evaluate the impact of hypertension and the use of ACEI/ARB on clinical severity in patients with COVID-19.

Methods
A total of 3,788 patients aged 30 years or older who were confirmed with COVID-19 with real time reverse transcription polymerase chain reaction were identified from a claims-based cohort in Korea. The primary study outcome was severe clinical events, a composite of intensive care unit admission, need for ventilator care, and death.

Results
Patients with hypertension (n = 1,190, 31.4 %) were older and had higher prevalence of comorbidities than those without hypertension. The risk of the primary study outcome was significantly higher in the hypertension group, even after multivariable adjustment (adjusted odds ratio [aOR], 1.67; 95 % confidence interval [CI], 1.04 to 2.69). Among 1,044 patients with hypertensive medical treatment, 782 (74.9 %) were on ACEI or ARB. The ACEI/ARB subgroup had a lower risk of severe clinical outcomes compared to the no ACEI/ARB group, but this did not remain significant after multivariable adjustment (aOR, 0.68; 95 % CI, 0.41 to 1.15).

Conclusions
Patients with hypertension had worse COVID-19 outcomes than those without hypertension, while the use of RAAS-blocking agents was not associated with increased risk of any adverse study outcomes. The use of ACE inhibitors or ARBs did not increase the risk of adverse COVID-19 outcomes, supporting current guidance to continue these medications when indicated.
ISSN
2056-5909
Language
English
URI
https://hdl.handle.net/10371/174788
DOI
https://doi.org/10.1186/s40885-021-00168-0
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