TY - JOUR
TI - Angiotensin-Converting Enzyme Inhibitors, Angiotensin II Receptor
Blockers, and Outcomes in Patients Hospitalized for COVID-19
AU - Pan, Michael
AU - Vasbinder, Alexi
AU - Anderson, Elizabeth
AU - Catalan,
AU - Toniemarie
AU - Shadid, Husam R.
AU - Berlin, Hanna
AU - Padalia, Kishan
AU - and O'Hayer, Patrick
AU - Meloche, Chelsea
AU - Azam, Tariq U. and
AU - Khaleel, Ibrahim
AU - Michaud, Erinleigh
AU - Blakely, Pennelope and
AU - Bitar, Abbas
AU - Huang, Yiyuan
AU - Zhao, Lili
AU - Pop-Busui, Rodica and
AU - Loosen, Sven H.
AU - Chalkias, Athanasios
AU - Tacke, Frank and
AU - Giamarellos-Bourboulis, Evangelos J.
AU - Reiser, Jochen
AU - Eugen-Olsen,
AU - Jesper
AU - Hayek, Salim S.
AU - ISIC Grp
JO - Journal of the American Heart Association
PY - 2021
VL - 10
TODO - 24
SP - null
PB - Wiley
SN - 2047-9980
TODO - 10.1161/JAHA.121.023535
TODO - ACE inhibitors; angiotensin receptor blockers; COVID-19; mortality;
outcomes
TODO - BACKGROUND: Use of angiotensin-converting enzyme inhibitors and
angiotensin receptor blockers (ACEi/ARB) is thought to affect COVID-19
through modulating levels of angiotensin-converting enzyme 2, the cell
entry receptor for SARS-CoV2. We sought to assess the association
between ACEi/ARB, biomarkers of inflammation, and outcomes in patients
hospitalized for COVID-19.
METHODS AND RESULTS: We leveraged the ISIC (International Study of
Inflammation in COVID-19), identified patients admitted for symptomatic
COVID-19 between February 1, 2020 and June 1, 2021 for COVID-19, and
examined the association between in-hospital ACEi/ARB use and all-cause
death, need for ventilation, and need for dialysis. We estimated the
causal effect of ACEi/ARB on the composite outcomes using marginal
structural models accounting for serial blood pressure and serum
creatinine measures. Of 2044 patients in ISIC, 1686 patients met
inclusion criteria, of whom 398 (23.6%) patients who were previously on
ACEi/ARB received at least 1 dose during their hospitalization for
COVID-19. There were 215 deaths, 407 patients requiring mechanical
ventilation, and 124 patients who required dialysis during their
hospitalization. Prior ACEi/ARB use was associated with lower levels of
soluble urokinase plasminogen activator receptor and C-reactive protein.
In multivariable analysis, in-hospital ACEi/ARB use was associated with
a lower risk of the composite outcome of in-hospital death, mechanical
ventilation, or dialysis (adjusted hazard ratio 0.49, 95% CI [0.36-
-0.65]).
CONCLUSIONS: In patients hospitalized for COVID-19, ACEi/ARB use was
associated with lower levels of inflammation and lower risk of
in-hospital outcomes. Clinical trials will define the role of ACEi/ARB
in the treatment of COVID-19.
ER -