Korean J Intern Med.
2021 May;36(3):617-628. 10.3904/kjim.2020.656.
Different therapeutic associations of renin-angiotensin system inhibitors with coronavirus disease 2019 compared with usual pneumonia
- Lee HY1,2,3
- Ahn J4
- Park J4
- Kang CK3
- Won SH4,5
- Kim DW6
- Park JH6,7
- Chung KH8,9
- Joh JS8
- Bang JH9,10
- Kang CH6
- Oh Md2,3,9
- Pyun WB
1,11 - The Korean Society of Hypertension
- The National Committee for Clinical Management of Emerging Infectious Diseases
- Affiliations
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- 1Korean Society of Hypertension, Seoul, Korea
- 2Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- 3Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- 4Department of Public Health Sciences, Seoul National University, Seoul, Korea
- 5Institute of Health and Environment, Seoul National University, Seoul, Korea
- 6National Health Insurance Service, Wonju, Korea
- 7Department of Benefits Strategy, National Health Insurance Service, Wonju, Korea
- 8National Medical Center, Seoul, Korea
- 9National Committee for Clinical Management of Emerging Infectious Diseases, Seoul, Korea
- 10The Central Infectious Disease Hospital, Seoul, Korea
- 11Division of Cardiology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
- KMID: 2515692
- DOI: http://doi.org/10.3904/kjim.2020.656
Abstract
- Background/Aims
Although it is near concluded that renin-angiotensin system inhibitors do not have a harmful effect on coronavirus disease 2019 (COVID-19), there is no report about whether angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) offer any protective role. This study aimed to compare the association of ARBs and ACEIs with COVID-19-related mortality.
Methods
All patients with COVID-19 in Korea between January 19 and April 16, 2020 were enrolled. The association of ARBs and ACEIs with mortality within 60 days were evaluated. A comparison of hazard ratio (HR) was performed between COVID-19 patients and a retrospective cohort of pneumonia patients hospitalized in 2019 in Korea.
Results
Among 10,448 COVID-19 patients, ARBs and ACEIs were prescribed in 1,231 (11.7%) and 57 (0.6%) patients, respectively. After adjusting for age, sex, and history of comorbidities, the ARB group showed neutral association (HR, 1.034; 95% CI, 0.765 to 1.399; p = 0.8270) and the ACEI groups showed no significant associations likely owing to the small population size (HR, 0.736; 95% CI, 0.314 to 1.726; p = 0.4810). When comparing HR between COVID-19 patients and a retrospective cohort of patients hospitalized with pneumonia in 2019, the trend of ACEIs showed similar benefits, whereas the protective effect of ARBs observed in the retrospective cohort was absent in COVID-19 patients. Meta-analyses showed significant positive correlation with survival of ACEIs, whereas a neutral association between ARBs and mortality.
Conclusions
Although ARBs or ACEIs were not associated with fatal outcomes, potential beneficial effects of ARBs observed in pneumonia were attenuated in COVID-19.
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