Impact of renin-angiotensin-aldosterone system inhibition on mortality in critically ill COVID-19 patients with pre-existing hypertension: a prospective cohort study

• Published in: BMC cardiovascular disorders Vol. 22; no. 1; pp. 123 - 12
• Main Authors: Sato, Kei, White, Nicole, Fanning, Jonathon P, Obonyo, Nchafatso, Yamashita, Michael H, Appadurai, Vinesh, Ciullo, Anna, May, Meryta, Worku, Elliott T, Helms, Leticia, Ohshimo, Shinichiro, Juzar, Dafsah A, Suen, Jacky Y, Bassi, Gianluigi Li, Fraser, John F, Arora, Rakesh C
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 23-03-2022; BioMed Central; BMC
• Subjects: ACE inhibitors; Aldosterone; Angiotensin; Angiotensin Receptor Antagonists - adverse effects; Angiotensin receptor blockers; Angiotensin-converting enzyme inhibitors; Angiotensin-Converting Enzyme Inhibitors - adverse effects; Antihypertensives; Blood pressure; Body mass index; Care and treatment; Cohort analysis; Cohort Studies; Complications and side effects; Consortia; Coronaviruses; COVID-19; Critical care; Critical Illness; Critically ill; Death; Diabetes; Disease; Dosage and administration; Enzymes; Extracorporeal membrane oxygenation; Health aspects; Hospital Mortality; Hospitalization; Hospitals; Humans; Hypertension; Hypertension - diagnosis; Hypertension - drug therapy; Hypothesis testing; Infections; Intensive care; Intensive care units; Laboratories; Length of stay; Mortality; Patients; Peptidyl-dipeptidase A; Prospective Studies; Renin; Renin-Angiotensin System; Retrospective Studies; Sensitivity analysis; Severe acute respiratory syndrome coronavirus 2; Statistical analysis; Survival analysis; Australia; Angiotensin-converting enzyme inhibitors; COVID-19; Severe acute respiratory syndrome coronavirus 2; Critical care; Angiotensin receptor blockers
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-022-02565-1

The influence of renin-angiotensin-aldosterone system (RAAS) inhibitors on the critically ill COVID-19 patients with pre-existing hypertension remains uncertain. This study examined the impact of previous use of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) on the critically ill COVID-19 patients.
Data from an international, prospective, observational cohort study involving 354 hospitals spanning 54 countries were included. A cohort of 737 COVID-19 patients with pre-existing hypertension admitted to intensive care units (ICUs) in 2020 were targeted. Multi-state survival analysis was performed to evaluate in-hospital mortality and hospital length of stay up to 90 days following ICU admission.
A total of 737 patients were included-538 (73%) with pre-existing hypertension had received ACEi/ARBs before ICU admission, while 199 (27%) had not. Cox proportional hazards model showed that previous ACEi/ARB use was associated with a decreased hazard of in-hospital death (HR, 0.74, 95% CI 0.58-0.94). Sensitivity analysis adjusted for propensity scores showed similar results for hazards of death. The average length of hospital stay was longer in ACEi/ARB group with 21.2 days (95% CI 19.7-22.8 days) in ICU and 6.7 days (5.9-7.6 days) in general ward compared to non-ACEi/ARB group with 16.2 days (14.1-18.6 days) and 6.4 days (5.1-7.9 days), respectively. When analysed separately, results for ACEi or ARB patient groups were similar for both death and discharge.
In critically ill COVID-19 patients with comorbid hypertension, use of ACEi/ARBs prior to ICU admission was associated with a reduced risk of in-hospital mortality following adjustment for baseline characteristics although patients with ACEi/ARB showed longer length of hospital stay. Clinical trial registration The registration number: ACTRN12620000421932; The date of registration: 30, March 2020; The URL of the registration: https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12620000421932 .