Association Between COVID-19 Mortality and ICU Admission Rates and Prior
History of Angiotensin-Converting Enzyme or Angiotensin Receptor
Blockers Use Among Hospitalized COVID-19 Patients with Hypertension in
Abstract: Importance: There are conflicting data
regarding the safety of the use of Angiotensin-converting enzyme
inhibitors or Angiotensin receptor blockers (ACEI/ARBs ) medications in
hypertensive patients who are susceptible to COVID-19.
Objective: Our study assesses the association between COVID-19
severity and mortality and the use of ACEI/ARBs among hospitalized
patients with hypertension. Research design, setting and
participants: This was a retrospective cohort study. Using the EPIC
system of Beaumont Health, we identified 5490 patients with COVID-19 who
were admitted to the eight Beaumont hospitals. After excluding subjects
who have no hypertension and those with missing data, we included 2129
COVID-19 patients who have hypertension. Logistic regression and Cox
proportional hazard models were used to analyze the association history
of ACEI/ARBs use, ICU admission rate and COVID-19 mortality.
Exposure: Using of ACEI/ARBs as documented in the medical
records before admission to the hospitals. Main outcome: 30
days COVID-19 mortality and ICU admission rates .
Results: There were 1281 subjects (60%) with prior ACEI/ARBs
use and 848 subjects ( 40%) with no ACEI/ARBs use. There was no
significant association between ICU admission and use of ACEI/ARBs (odds
ratio was 0.95, 95% CI [0.76, 1.19] and p-value was 0.6). Although
the unadjusted logistic regression model demonstrated a statistically
significant association between history of use of ACEI/ARBs and COVID-19
mortality (odds ratio= 1.31, 95% CI [1.05, 1.66], p-value= 0.02),
the adjusted logistic regression model failed to show this statistically
significant association (odds ratio= 1.20, 95% CI [0.93, 1.54],
p-value= 0.14). Moreover, we were not able to reveal a statistically
significant association between 30 days COVID-19 survival and prior use
of ACEI/ARBs in the adjusted Cox-proportional hazard model (Hazard ratio
(HR) = 1.11, 95% CI [0.91, 1.40], p-value =0.14).
Conclusion: In a large retrospective study, we conclude that
there was no statistically significant association between prior history
of ACEI/ARBs use and COVID-19 ICU admission rates or mortality in
hypertensive patients hospitalized with COVID-19.