Renin--angiotensin system inhibitor is associated with the reduced risk of all-cause mortality in COVID-19 among patients with/without hypertension

Abstract

Consecutively hospitalized patients with confirmed coronavirus disease 2019 (COVID-19) in Wuhan, China were retrospectively enrolled from January 2020 to March 2020 to investigate the association between the use of renin–angiotensin system inhibitor (RAS-I) and the outcome of this disease. Associations between the use of RAS-I (angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB)), ACEI, and ARB and in-hospital mortality were analyzed using multivariate Cox proportional hazards regression models in overall and subgroup of hypertension status. A total of 2771 patients with COVID-19 were included, with moderate and severe cases accounting for 45.0% and 36.5%, respectively. A total of 195 (7.0%) patients died. RAS-I (hazard ratio (HR)=0.499, 95% confidence interval (CI) 0.325–0.767) and ARB (HR=0.410, 95% CI 0.240–0.700) use was associated with a reduced risk of all-cause mortality among patients with COVID-19. For patients with hypertension, RAS-I and ARB applications were also associated with a reduced risk of mortality with HR of 0.352 (95% CI 0.162–0.764) and 0.279 (95% CI 0.115–0.677), respectively. RAS-I exhibited protective effects on the survival outcome of COVID-19. ARB use was associated with a reduced risk of all-cause mortality among patients with COVID-19.

Keywords

COVID-19 / RAS inhibitor / hypertension / all-cause mortality

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Acknowledgements

This study was supported by grants from Special Research Fund of PKU for Prevention and Control of COVID-19 and the Fundamental Research Funds for the Central Universities (Nos. PKU2020PKYZX003 and BMU2020HKYZX007), the National Natural Science Foundation of China (Nos. 91846101, 81771938, 81301296, 81900665, 81570667, 81470948, and 81670633), Major Research Plan of the National Natural Science Foundation of China (No. 91742204), The International (Regional) Cooperation and Exchange Projects (NSFC-DFG, No. 81761138041), Beijing Nova Programme Interdisciplinary Cooperation Project (No. Z191100001119008), the National Key R&D Program of the Ministry of Science and Technology of China (Nos. 2016YFC1305405, 2019YFC2005000, 2018YFC1314003-1, and 2015BAI12B07), National Key Research and Development Program (No. 2016YFC0906103), the University of Michigan Health System-Peking University Health Science Center Joint Institute for Translational and Clinical Research (Nos. BMU20160466, BMU2018JI012, and BMU2019JI005), Beijing Advanced Discipline Construction Project (No. BMU2019GJJXK001), PKU-Baidu Fund (No. 2019BD017) and from Peking University (Nos. BMU2018MX020 and PKU2017LCX05).

Compliance with ethics guidelines

Huai-yu Wang, Suyuan Peng, Zhanghui Ye, Pengfei Li, Qing Li, Xuanyu Shi, Rui Zeng, Ying Yao, Fan He, Junhua Li, Liu Liu, Shuwang Ge, Xianjun Ke, Zhibin Zhou, Gang Xu, Ming-hui Zhao, Haibo Wang, Luxia Zhang, and Erdan Dong declare no conflict of interests. This study was conducted with the authorization of National Health Commission of the People Republic of China and was approved by the Ethics Committee of Peking University Health Science Center (IRB00001052-20032) .

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