Outcomes Associated with the Use of Renin-Angiotensin-Aldosterone System Blockade in Hospitalized Patients with SARS-CoV-2 Infection

Background Data regarding the benefits or harm associated with the continuation of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), especially the effect on inflammation, in patients who are hypertensive and hospitalized with coronavirus disease 2019 (COVID-19) in the United States are unclear. Methods This is a single-center cohort study of patients sequentially hospitalized with COVID-19 at Stony Brook University Medical Center from March 7, 2020 to April 1, 2020, inclusive of these dates. Data collection included history of known comorbidities, medications, vital signs, and laboratory values (at admission and during the hospitalization). Outcomes include inflammatory burden (composite scores for multiple markers of inflammation), AKI, admission to the intensive care unit (ICU), need for invasive mechanical ventilation, and mortality. Results Of the 300 patients in the study cohort, 80 patients (27%) had history of ACEI or ARB use before admission, with 61% (49/80) of these patients continuing the medications during hospitalization. Multivariable analysis revealed that the history of ACEI or ARB use before hospitalization was not associated with worse outcomes. In addition, the continuation of these agents during hospitalization was not associated with an increase in adverse outcomes and predicted fewer ICU admissions (odds ratio, 0.25; 95% CI, 0.08 to 0.81) with a decrease in the severity of inflammatory burden (peak C-reactive protein, 6.9 +/- 3.1 mg/dl, P=0.03; peak inflammation score, 2.3 +/- 1.1 unit reduction, P=0.04). Conclusions Use of ACEI or ARBs before hospitalization was not associated with adverse outcomes in COVID-19, and the therapeutic benefits of continuing ACEI or ARB in patients hospitalized with COVID-19 was not offset by adverse outcomes.