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Inpatient Omission of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Is Associated With

Christopher Oddy1, Jonathan Allington1, James McCaul1

  • 1St. Helier Hospital, London, United Kingdom.

Clinical Therapeutics
|March 13, 2021
PubMed

Insights

Continuing ACE inhibitors and ARBs in hospitalized COVID-19 patients is crucial. Missing doses of these medications was linked to higher mortality and worse clinical outcomes in patients with COVID-19.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Pharmacology

Background:

  • Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) targets the human angiotensin-converting enzyme 2 (ACE2) receptor.
  • The use of ACE inhibitors and angiotensin receptor blockers (ARBs) in patients with COVID-19 raised clinical concerns during the 2020 pandemic.
  • Previous meta-analyses indicated no worsening of clinical outcomes with ACE inhibitors/ARBs in SARS-CoV-2 infection, but direct evidence on inpatient use during acute illness was limited.

Purpose of the Study:

  • To investigate the impact of inpatient ACE inhibitor/ARB use on morbidity and mortality in hospitalized COVID-19 patients.
  • To evaluate the safety and clinical outcomes associated with continuing or discontinuing ACE inhibitors/ARBs during acute COVID-19 illness.

Main Methods:

  • A retrospective cohort analysis included 612 adult patients admitted to the hospital with COVID-19.
  • Patients were categorized based on their established use of ACE inhibitors/ARBs.
  • Linear and logistic regression models were used to explore relationships, controlling for known confounders.

Main Results:

  • Of 612 patients, 151 (24.7%) were on ACE inhibitors/ARBs.
  • Discontinuation of ACE inhibitors/ARBs was a significant predictor of worsened outcomes.
  • Missed doses were strongly associated with increased mortality (OR, 9.59), higher National Early Warning Score 2 (OR, 1.66), greater oxygen requirements (OR, 3.00), and elevated C-reactive protein levels (OR, 1.83).

Conclusions:

  • Missed doses of ACE inhibitors/ARBs in hospitalized COVID-19 patients correlate with increased morbidity and mortality.
  • Current practice of continuing ACE inhibitor/ARB therapy during acute illness, with careful monitoring and timely reinitiation, is supported by these findings.
  • The study advocates for limiting drug omission to acute contraindications and resuming therapy when safe.
Abstract

Keywords:
Angiotensin receptor blockersAngiotensin-converting enzyme inhibitorsCOVID-19InpatientSARS-CoV-2Severe acute respiratory syndrome coronavirus 2

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