Chronic use of renin–angiotensin–aldosterone inhibitors in hypertensive COVID-19 patients: Results from a Spanish registry and meta-analysis

Hypertension is a prevalent condition among SARS-CoV-2 infected patients. Whether renin–angiotensin–aldosterone system (RAAS) inhibitors are beneficial or harmful is controversial. We have performed a national retrospective, nonexperimental comparative study from two tertiary hospitals to evaluate t...

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Published in:Medicina clínica (English ed.) 2022-04, Vol.158 (7), p.315-323
Main Authors: Aparisi, Álvaro, Catalá, Pablo, Amat-Santos, Ignacio J., Marcos-Mangas, Marta, López-Otero, Diego, Veras, Carlos, López-Pais, Javier, Cabezón-Villalba, Gonzalo, Cacho Antonio, Carla Eugenia, Candela, Jordi, Antúnez-Muiños, Pablo, Gil, José Francisco, González Ferrero, Teba, Rojas, Gino, Pérez-Poza, Marta, Uribarri, Aitor, Otero-García, Oscar, García-Granja, Pablo Elpidio, Jiménez Ramos, Víctor, Revilla, Ana, Dueñas, Carlos, Gómez, Itzíar, González-Juanatey, José Ramón, San Román, J. Alberto
Format: Article
Language:English
Subjects:
Angiotensin II receptor blockers
Angiotensin-converting-enzyme inhibitors
Antagonistas de los receptores de la angiotensina II
COVID-19
Hipertensión arterial
Hypertension
Inhibidores de la enzima convertidora de angiotensina
Meta-analysis
Metaanális
Original
SARS-CoV-2
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Summary:Hypertension is a prevalent condition among SARS-CoV-2 infected patients. Whether renin–angiotensin–aldosterone system (RAAS) inhibitors are beneficial or harmful is controversial. 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. 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. 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. La hipertensión es una condición prevalente entre los pacientes infectados por el SARS-CoV-2. Es controvertido si los inhibidores del sistema renina-angiotensina-aldosterona (SRAA) son beneficiosos o perjudiciales. Hemos desarrollado un estudio comparativo nacional retrospectivo y no experimental en 2 hospitales terciarios para evaluar el impacto del uso crónico de inhibidores del SRAA en pacientes hipertensos con COVID-19. Se realizó un metaanálisis para reforzar los hallazgos. De 849 pacientes, 422 (49,7%) eran hipertensos y 310 (73,5%) tomaban inhibidores del SRAA al inicio del estudio. Los pacientes hipertensos eran mayores, tenían más comorbilidades y una mayor incidencia de insuficiencia respiratoria (−0,151; IC 95%: [−0,218; −
ISSN:2387-0206
2387-0206
DOI:10.1016/j.medcle.2021.04.026