Influence of angiotensin receptor and converting enzyme blockers therapy in the respiratory outcome of COVID-19 hospitalized patients

Felipe B Lima; Francisco Wilker Mustafa Gomes Muniz; Gdayllon C Meneses; Karine C Bezerra; Carolyne N Moreira; André P Aguiar; José Carlos R Nascimento; Tainá Veras de S Freitas; Pedro Felipe C de Bruin; Eanes Delgado B Pereira; Elizabeth de F Daher; Reinaldo B Oriá

doi:10.1016/j.medcli.2023.10.004

Influence of angiotensin receptor and converting enzyme blockers therapy in the respiratory outcome of COVID-19 hospitalized patients

Med Clin (Barc). 2024 Feb 23;162(4):163-169. doi: 10.1016/j.medcli.2023.10.004. Epub 2023 Nov 23.

[Article in English, Spanish]

Affiliations

¹ Laboratory of the Biology of Tissue Healing, Ontogeny and Nutrition, Department of Morphology and Institute of Biomedicine, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil; Department of Anesthesiology, Hospital Geral de Fortaleza (HGF), Fortaleza, CE, Brazil.
² Department of Periodontology, Federal University of Pelotas, Pelotas, RS, Brazil.
³ Clinical Medicine Department, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil.
⁴ Laboratory of the Biology of Tissue Healing, Ontogeny and Nutrition, Department of Morphology and Institute of Biomedicine, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil.
⁵ Laboratory of the Biology of Tissue Healing, Ontogeny and Nutrition, Department of Morphology and Institute of Biomedicine, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil. Electronic address: oria@ufc.br.

PMID: 38000940
DOI: 10.1016/j.medcli.2023.10.004

Abstract

Objectives: COVID-19, caused by SARS-CoV-2, has spread around the world since 2019. In severe cases, COVID-19 can lead to hospitalization and death. Systemic arterial hypertension and other comorbidities are associated with serious COVID-19 infection. Literature is unclear whether antihypertensive therapy with angiotensin receptor blockers (ARBs) and angiotensin converting enzyme (ACE) inhibitors affect COVID-19 outcomes. We aim to assess whether ACEI/ARB therapy is a risk factor for worse respiratory outcomes related to COVID-19 in hospitalized patients.

Methods: Retrospective study enrolling admitted COVID-19-diagnosed patients by RT-PCR at the Hospital Geral de Fortaleza, Brazil, during 2021. Patient medical records, sociodemographic, and clinical data were analyzed. Chest CT images were analyzed using CAD4COVID-CT/Thirona™ software.

Results: A total of 294 patients took part in the study. A cut-off point of 66% of pulmonary involvement was found by ROC curve, with patients having higher risk of death and intubation and lower 60-day survival. Advanced age (RR 1.025, P=0.001) and intubation (RR 16.747, P<0.001) were significantly associated with a higher risk of death. Advanced age (RR 1.023, P=0.001) and the use of noninvasive ventilation (RR 1.548, P=0.037) were associated with a higher risk of intubation. Lung involvement (>66%) increased the risk of death by almost 2.5-fold (RR 2.439, P<0.001) and by more than 2.3-fold the risk of intubation (RR 2.317, P<0.001).

Conclusions: Altogether, our findings suggest that ACEI or ARB therapy does not affect the risk of death and disease course during hospitalization.

Keywords: Angiotensin-converting enzyme 2; Antihipertensivos; Antihypertensive agents; Artificial intelligence; Enzima convertidora de angiotensina 2; Hipertensión; Hypertension; Inteligencia artificial; Lung; Pulmón; Renin–angiotensin system; Sistema renina-angiotensina.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Angiotensin Receptor Antagonists / adverse effects
Angiotensin-Converting Enzyme Inhibitors / adverse effects
COVID-19* / complications
Humans
Hypertension* / drug therapy
Hypertension* / epidemiology
Receptors, Angiotensin / therapeutic use
Retrospective Studies
SARS-CoV-2

Substances

Angiotensin-Converting Enzyme Inhibitors
Angiotensin Receptor Antagonists
Receptors, Angiotensin