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2nd December 2021
Inhibition of the renin-angiotensin-aldosterone system (RAAS inhibition) reduces mortality in those hospitalised with COVID-19 and admitted to an intensive care unit. This was the finding of a retrospective analysis presented at the American Heart Association (AHA) conference 2021.
Inhibition of the RAAS system can be achieved through the use of both angiotensin converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs). Although it has become widely accepted that the COVID-19 virus gains entry to cells via the angiotensin converting enzyme 2 receptor, whether existing use of drugs affecting the RAAS system affects the outcomes of those with more severe COVID-19 infection remains uncertain.
For the present study, researchers turned to the COVID-19 Critical Care Consortium which represents 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.
A total of 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.
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