Differences among renin-angiotensin system inhibitor drugs in prognosis of hypertense patients with COVID-19

Martín Negreira-Caamaño, Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
Jorge Martínez-Del-Río, Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real, Castilla-La Mancha, España
Patricia Nieto-Sandoval-Martín-de-la-Sierra, Servicio de Farmacia. Hospital General Universitario de Ciudad Real, Ciudad Real, Castilla-La Mancha, España
Daniel Águila-Gordo, Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real, Castilla-La Mancha, España
Cristina Mateo-Gómez, Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real, Castilla-La Mancha, España
Marta Rodríguez-Martínez, Servicio de Farmacia. Hospital General Universitario de Ciudad Real, Ciudad Real, Castilla-La Mancha, España
Daniel Salas-Bravo, Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real, Castilla-La Mancha, España
Jesús Piqueras-Flores, Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real; Facultad de Medicina, Universidad de Castilla-La Mancha. Ciudad Real, Castilla-La Mancha, España

Background: Concerns have been raised about Renin-angiotensin system inhibitors (RASi) in patients with COVID-19. Although recent trials have proved its security, evidence regarding intrinsic differences between RASi is lacking, especially in patients with arterial hypertension. Objective: Our objective was to analyse the prognosis of hypertense patients who received angiotensin converting enzyme inhibitors (ACEi) or angiotensin-2 receptor blockers (ARBs) and were hospitalized due to COVID-19. Methods: 392 consecutive patients with hypertension and COVID-19 were analyse. Incidence of the combined event (death or mechanical ventilation need) was the primary endpoint. Secondary, incidence of each event and time to event were analysed. Results: 155 received ACEi and 237 ARBs. During the hospitalization, the combined event was observed in the 31,6 % of patients. No differences were observed between those previously treated with ACEi and ARBs (33.5 vs. 30.9%; p = 0.51). In the survival analysis, no differences were observed regarding time to combined event (p = 0.91). In-hospital mortality was similar in both groups (32.3 vs. 29.1%; p = 0.51), as well as the need of mechanical ventilation (3.2 vs. 5.9%; p = 0.23). Conclusions: The type of RASi was not associated with in-hospital major events in patients with arterial hypertension hospitalized due to COVID-19.

Keywords: Arterial hypertension. COVID-19. Renin-angiotensin system inhibitors. Angiotensin converting enzyme inhibitors (ACEi). Angiotensin-2 receptor blockers (ARBs).