Diabetes Metab J.  2021 May;45(3):430-438. 10.4093/dmj.2020.0279.

Use of Renin-Angiotensin-Aldosterone System Inhibitors and Severe COVID-19 Outcomes in Patients with Hypertension: A Nationwide Cohort Study

• Bae JH
• Choi SK
• Kim NH
• Lee J
• Kim SG

• KMID: 2516344
• DOI: http://doi.org/10.4093/dmj.2020.0279

Abstract

Background
Angiotensin-converting enzyme 2 facilitates the entry of severe acute respiratory syndrome coronavirus 2 into the human body. We investigated the association of renin-angiotensin-aldosterone system (RAAS) inhibitor use with severe coronavirus disease 2019 (COVID-19) outcomes in hypertensive patients.
Methods
We identified hypertensive patients with confirmed COVID-19 from the Korean Health Insurance Review and Assessment Service from inception to May 15, 2020. The primary outcome was the composite of intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), continuous renal replacement therapy (CRRT), extracorporeal membrane oxygenation (ECMO), and death from COVID-19. The individual components were evaluated as secondary outcomes.
Results
Of 1,374 hypertensive patients with COVID-19, 1,076 (78.3%) and 298 (21.7%) were users and never-users of RAAS inhibitors, respectively. The RAAS inhibitor users were not associated with the risk of the primary outcome (adjusted odds ratio [aOR], 0.72; 95% confidence interval [CI], 0.46 to 1.10). The risk of ICU admission was significantly lower in the users than the never-users (aOR, 0.44; 95% CI, 0.24 to 0.84). The RAAS inhibitors were beneficial only in ICU admissions that did not require IMV (aOR, 0.28; 95% CI, 0.14 to 0.58). The risk of death from COVID-19 was comparable between the groups (aOR, 1.09; 95% CI, 0.64 to 1.85). We could not evaluate the risks of CRRT and ECMO owing to the small number of events.
Conclusion
RAAS inhibitor use was not associated with the composite of severe outcomes in the hypertensive patients with COVID-19 but significantly lowered the risk of ICU admission, particularly in patients who did not require IMV.

Keyword

Angiotensin-converting enzyme inhibitors; Angiotensin receptor antagonists; COVID-19; Hypertension; Renin-angiotensin system; Respiration, artificial

Figure

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  Fig. 1. A flow diagram of the patient selection. COVID-19, coronavirus disease 2019; RAAS, renin-angiotensin-aldosterone system; ARB, angiotensin-receptor blocker; ACEI, angiotensin-coverting enzyme inhibitor.

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  Fig. 2. Risk factors for the primary outcome and intensive care unit (ICU) admission. (A) Primary outcome. (B) ICU admission. (C) ICU admission not requiring invasive mechanical ventilation (IMV). (D) ICU admission requiring IMV. Age was regarded as a continuous variable. Separate analyses were performed to calculate odds ratio (ORs) of angiotensin-receptor blocker (ARB) and angiotensin-coverting enzyme inhibitor (ACEI). Values for ORs are plotted on a log scale. RAAS, renin-angiotensin-aldosterone system; CI, confidence interval; DM, diabetes mellitus; CVD, cardiovascular disease; CKD, chronic kidney disease; CPD, chronic pulmonary disease; CCI, Charlson Comorbidity Index.

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