The Association between Chronic Use of Renin–AngiotensinAldosterone System Blockers and in-Hospital Adverse Events among COVID-19 Patients with Hypertension

Özet

Objectives: The effects of chronic renin–angiotensin–aldosterone system (RAAS) blockers usage on adverse outcomes and disease severity remain uncertain in COVID-19 patients with hypertension. In this study, we aimed to determine the relationshipbetween chronic use of RAAS inhibitors and in-hospital adverse events among hypertensive patients hospitalized with COVID-19.Methods: In this retrospective single-center study, we enrolled 349 consecutive hypertensive patients diagnosed with COVID-19infection. All patients were chronically on angiotensin-converting enzyme inhibitors (ACEI)/ angiotensin II receptor blockers (ARB)or other antihypertensive therapies before hospital admission. Adverse clinical events were defined as in-hospital mortality, admission to intensive care unit, need for high-flow oxygen and intubation.Results: Patients were categorized into two groups according to the type of antihypertensive therapy. (ACEI/ARBs users, N=201;ACEI/ARB nonusers, N=148) There was no statistically significant difference between ACEI/ARBs users and ACEI/ARBs nonusersconcerning adverse clinical events, such as in-hospital mortality (29 (14.4%) vs. 20 (13.5%), p=0.81), ICU admission (45(22.4%)vs. 27 (18.2%), p=0.34), need for high-flow oxygen (97 (48.3%) vs. 68 (45.9%), p=0.67) and need for intubation (32(15.9%) vs.23(15.5%), p=0.92), respectively. Also, the severity of infection did not differ among groups. The logistic regression multivariateanalysis showed that age, neutrophil-lymphocyte ratio, procalcitonin and ferritin levels were independent predictors of in-hospitalmortality.Conclusion: Our results suggest that chronic use of ACEI/ARBs did not increase in-hospital adverse outcomes of hypertensivepatients hospitalized with COVID-19. Although the recent data are contradictory, chronic ACEI/ARB therapy is not recommendedto be discontinued in hypertensive patients during their hospitalization for COVID-19.