Comparing clinical outcomes of ARB and ACEi in patients hospitalized for acute COVID-19

Continued receipt of Renin-Angiotensin-Aldosterone inhibitors in patients with COVID-19 has shown potential in producing better clinical outcomes. However, superiority between ACEi (angiotensin-converting enzyme inhibitors) and ARB (angiotensin II receptor blockers) regarding clinical outcomes in this setting remains unknown. We retrospectively collected data on patients hospitalized for acute COVID-19 using the nationwide administrative database (Diagnosis and Procedure Combinations, DPC). The DPC data covered around 25% of all acute care hospitals in Japan. Patient outcomes, with focus on inpatient mortality, were compared between patients previously prescribed ACEi and those prescribed ARB. Comparisons based on crude, multivariate and propensity-score adjusted analysis were conducted. We examined a total of 7613 patients (ARB group, 6903; ACEi group 710). The ARB group showed lower crude in-hospital mortality, compared to the ACEi group (5% vs 8%; odds ratio, 0.65; 95% CI 0.48-0.87), however not in the multivariate-adjusted model (odds ratio, 0.95; 95% CI 0.69-1.3) or propensity-score adjusted models (odds ratio, 0.86; 95% CI 0.63-1.2). ARB shows potential in reducing hospital stay duration over ACEi in patients admitted for COVID-19, but does not significantly reduce in-hospital mortality. Further prospective studies are needed to draw a definitive conclusion, but continuation of either of these medications is warranted to improve clinical outcomes.

Automated summary

Continued use of Renin-Angiotensin-Aldosterone inhibitors in COVID-19 patients may lead to better clinical outcomes. However, it is still unknown whether ACEi or ARB is superior in terms of clinical outcomes. A retrospective study in Japan found that ARB had potential in reducing hospital stay duration, but did not significantly reduce in-hospital mortality compared to ACEi. Further prospective studies are needed to draw a definitive conclusion.