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Hypertension, renin-angiotensin-aldosterone-system-blocking agents, and COVID-19
Si-Hyuck Kang1,2,3, Dong-Hoon Lee1, Kyung-Do Han4
1Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Insights
Hypertension increases COVID-19 severity, but renin-angiotensin-aldosterone-system (RAAS)-blocking agents like ACE inhibitors (ACEI) and ARBs do not raise adverse outcomes. Continue these vital medications for hypertension patients during COVID-19.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- Concerns existed regarding renin-angiotensin-aldosterone-system (RAAS)-blocking agents safety during the COVID-19 pandemic.
- This study investigated hypertension and RAAS-blocking agent use (ACEI/ARB) impact on COVID-19 clinical severity.
Purpose of the Study:
- To evaluate the association between hypertension and COVID-19 clinical severity.
- To assess the safety of ACEI/ARB use in hypertensive patients with COVID-19.
Main Methods:
- A cohort of 3,788 COVID-19 patients (≥30 years) from Korea was analyzed.
- Severe clinical events (ICU admission, ventilation, death) were the primary outcome.
Main Results:
- Hypertension was linked to significantly higher severe COVID-19 outcomes (aOR, 1.67; 95% CI, 1.04-2.69).
- Among treated hypertensive patients, ACEI/ARB use (74.9%) showed a non-significant trend towards lower severe outcomes (aOR, 0.68; 95% CI, 0.41-1.15).
Conclusions:
- Hypertension is a significant risk factor for worse COVID-19 outcomes.
- RAAS-blocking agents (ACEI/ARB) were not associated with increased adverse COVID-19 outcomes, supporting their continued use.
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.
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