Inhibiting of the renin-angiotensin-aldosterone system (RAAS inhibition) in patients hospitalised with COVID-19 and admitted to an intensive care unit leads to a reduction in reduces mortality. This is according to a retrospective analysis presented at the American Heart Association (AHA) conference 2021.
Both angiotensin converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) are able to inhibit the RAAS system and with widespread acceptance that the COVID-19 virus gains entry to cells via the angiotensin converting enzyme 2 receptor, the impact of drugs which affect the RAAS system on outcomes among those with more severe infection remains uncertain.
In the AHA presentation, researchers used data held in the COVID-19 Critical Care Consortium, a global database of de-identified information on treatment outcomes of critically ill COVID-19 patients. The critical care consortium includes data from 354 centres in 54 countries and thus represents an important source of information for researchers as it generates a huge amount of clinical insight about the virus.
The stated aim of the study was to examine the role of ACEi / ARB drug exposure (i.e., RAAS inhibition) on outcomes in COVID-19 patients with prior hypertension (HTN) and who had been admitted to intensive care units (ICU) due to the severity of their infection.
For the analysis, researchers focused on adult patients (i.e., >18 years of age) and with pre-existing HTN. Outcomes of interest included the length of stay and in-hospital mortality to 90 days post ICU admission.
Findings
There were 663 eligible patients were included in the analysis, of whom, 480 patients, with a median age of 65 years (67% male) had been prescribed an ACEi and / or ARB therapy in the 2 weeks before ICU admission. The average lengths of stays in both ICU and a general ward were longer in those prescribed ACEi / ARB drugs compared to non-users (20.8 days and 6.5 days vs. 15.5 and 6.0 days, respectively).
However, RAAS inhibition treatment was associated with a decreased risk of death (Hazard ratio, HR = 0.69, 95% CI 0.54 — 0.88) which persisted after adjusting for propensity scores (HR = 0.67, 95% CI 0.53 — 0.86).
Based on these findings, the authors concluded that the use of ACEi/ARB’s for the management of pre-existing hypertension was associated with a reduced mortality risk in those admitted to an ICU after admission to hospital due to the severity of their COVID-19 infection.
Citation
Sato K et al. Abstract 10482: Renin-Angiotensin-Aldosterone System Inhibition is Associated with Reduced In-Hospital Mortality in Critically Ill Covid-19 Patients with Pre-Existing Hypertension. Circulation 2021.
