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Effects of Losartan on Patients Hospitalized for Acute COVID-19: A Randomized Controlled Trial

Karen C Tran1, Pierre Asfar2, Matthew Cheng3

  • 1Division of General Internal Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, Canada.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|September 26, 2024
PubMed
Abstract

Insights

Losartan did not reduce 28-day mortality in hospitalized COVID-19 patients and increased serious adverse events like hypotension. Researchers advise caution when using angiotensin receptor blockers (ARBs) in hospitalized pneumonia patients.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Pharmacology

Background:

  • Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may alter the renin-angiotensin system, potentially increasing angiotensin II levels.
  • This alteration prompted investigation into whether angiotensin receptor blockers (ARBs) could mitigate COVID-19 severity.

Purpose of the Study:

  • To evaluate the efficacy and safety of losartan compared to usual care in reducing 28-day mortality among hospitalized patients with coronavirus disease 2019 (COVID-19).

Main Methods:

  • A randomized controlled trial involving 341 adult patients admitted for acute COVID-19 across 29 hospitals in Canada and France.
  • Participants were assigned to receive either losartan (25-100 mg/day) or usual care, with 28-day mortality as the primary outcome.
  • Exclusion criteria included hypotension, hyperkalemia, acute kidney injury, and recent use of ARBs or ACE inhibitors.

Main Results:

  • The trial was terminated early due to safety concerns associated with losartan.
  • Serious adverse events (39.8% vs 27.2%) and hypotension (30.4% vs 15.3%) were significantly higher in the losartan group compared to the usual care group.
  • No significant difference was observed in 28-day mortality (6.5% vs 5.9%) between the losartan and usual care arms.

Conclusions:

  • Losartan should not be added to the care of patients hospitalized for acute COVID-19.
  • Caution is advised regarding the use of ARBs in hospitalized pneumonia patients due to risks of hypotension and other adverse effects.
Keywords:
COVID-19angiotensin receptor blockerlosartanmortality

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