Effect of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) among hypertensive patients with coronavirus disease 2019 (COVID-19) is debated. The aim of the COVIDECA study was to assess the outcome of ACEI and ARB among hypertensive patients presenting with COVID-19. We reviewed from the Assistance Publique-Hôpitaux de Paris healthcare record database all patients presenting with confirmed COVID-19 by RT-PCR. We compared hypertensive patients with ACEI or ARB and hypertensive patients without ACEI and ARB. Among 13,521 patients presenting with confirmed COVID-19 by RT-PCR, 2,981 hypertensive patients (mean age: 78.4 ± 13.6 years, 1,464 men) were included. Outcome of hypertensive patients was similar whatever the use or non-use of ACEI or ARB: admission in ICU (13.4% in patients with ACEI or ARB versus 14.8% in patients without ACEI/ARB, p = 0.35), need of mechanical ventilation (5.5% in patients with ACEI or ARB vs 6.3% in patients without ACEI/ARB, p = 0.45), in-hospital mortality (27.5% in patients with ACEI or ARB vs 26.7% in patients without ACEI/ARB, p = 0.70). In conclusion, the use of ACEI and ARB remains safe and can be maintained in hypertensive patients presenting with COVID-19.
Effect of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) among hypertensive patients with coronavirus disease 2019 (COVID-19) is debated. Hypertension is associated with a higher risk of severity and mortality in patients presenting with COVID-19. Angiotensin converting enzyme inhibitor and ARB are widely used in hypertension and some concerns occurred concerning ACEI and ARB in COVID-19 patients. Indeed, some experimental studies found that ACEI and ARB exposures increased the expression of ACE2 receptor, which is the known cellular receptor and a necessary entry point for acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but these findings were not confirmed in humans. Furthermore, conflicting results in hypertensive patients with ACEI and ARB were published. The aim of the COVIDECA study was to assess the outcome of ACEI and ARB among hypertensive patients presenting with COVID-19.
Methods
We reviewed from the Assistance Publique-Hôpitaux de Paris (AP-HP) healthcare record database all patients presenting with confirmed COVID-19 by RT-PCR. AP-HP is the largest university hospital center (39 hospitals) in Europe and was completely involved in COVID-19 pandemic. Criteria for selection included age > 18 years, confirmed COVID-19 by RT-PCR and a previous history of hypertension. Patients were included between March 12 and June 1, 2020. We identified hypertensive patients with ACEI or ARB from hypertensive patients without ACEI and ARB. We assessed admission in intensive care unit (ICU), mechanical ventilation and death as in-hospital outcome of all hypertensive patients. The COVIDECA study (CSE-20-23) was approved by the EDS APHP Ethics Committee (Comité Scientifique et Éthique de l’Entrepôt de Données de Santé [ https://eds.aphp.fr ]).
Results
We identified 13,521 patients presenting with confirmed COVID-19 by RT-PCR. Mean age of this population was 66.5 ± 19.2 years (men: 7,103, 52.5%). Among these patients, 2,981 hypertensive patients (mean age: 78.4 ± 13.6 years, 1,464 [49.1%] men) were included in the study. Characteristics of the hypertensive population are presented in Table 1 . Patients with ACEI or ARB had more likely diabetes (p < 0.0001), chronic kidney disease (p = 0.02), coronary artery disease (p = 0.005) and heart failure (p = 0.04).
| Variable | All hypertensive patients (n = 2,981) | Hypertensive patients with ACEI or ARB (n = 946) | Hypertensive patients without ACEI/ARB (n = 2,035) | p Value |
|---|---|---|---|---|
| Mean age (years) | 78.4 ± 13.6 | 78.7 ± 12.4 | 78.3 ± 14.1 | 0.32 |
| Men | 1464 (49.1%) | 467 (49.4%) | 997 (49%) | 0.09 |
| Body mass index | 26.4 ± 6.6 | 26.6 ± 6.9 | 26.4 ± 6.4 | 0.75 |
| COPD | 161 (5.4%) | 60 (6.3%) | 101 (5%) | 0.14 |
| Obstructive sleep apnea | 254 (8.5%) | 93 (9.8%) | 161 (7.9%) | 0.19 |
| Diabetes | 1031 (34.6%) | 415 (43.9%) | 616 (30.3%) | <0.0001 |
| Chronic kidney disease | 414 (13.9%) | 152 (16.1%) | 262 (12.9%) | 0.02 |
| Coronary artery disease | 599 (20.1%) | 219 (23.2%) | 380 (18.7%) | 0.005 |
| Heart failure | 822 (27.6%) | 258 (27.3%) | 564 (27.7%) | 0.04 |
| Outcome | ||||
| Admission in ICU | 428 (14.4%) | 127 (13.4%) | 301 (14.8%) | 0.35 |
| Mechanical ventilation | 180 (6%) | 52 (5.5%) | 128 (6.3%) | 0.45 |
| Death | 804 (27%) | 260 (27.5%) | 544 (26.7%) | 0.70 |
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
