Differential effects of Angiotensin-Converting Enzyme Inhibitors and
Angiotensin II Receptor Blockers on COVID-19
Abstract
AIMS To report the major characteristics and clinical outcomes of
COVID-19 patients treated with ACE inhibitors and ARBs and compare the
different effects of the two drugs for outcomes of COVID-19 patients.
METHODS This is a retrospective, two-center case series of 198
consecutive COVID-19 patients with a history of hypertension. RESULTS
Among 198 patients, 58 (29.3%) and 16 (8.1%) were on were on ARB and
ACEI, respectively. Patients who were on ARB or ACEI/ARB had a
significantly lower rate of severe illness and ARDS when compared with
patients treated with ACEI alone or not receiving RAAS blocker
(P<0.05). The Kaplan-Meier survival curve showed that patients with ARB
in their antihypertensive regimen had a trend towards a higher survival
rate when compared with individuals without ARB (adjusted hazard ratio,
0.27; 95% CI, 0.07-1.02; P=0.054). The occurrence rates of severe
illness, ARDS, and death were similar in the two groups regardless of
receiving ACEI. The Cox-regression analysis to compared ACEI vs. ARB
groups showed a significantly lower mortality rate in the ARB group
(adjusted hazard ratio, 0.03; 95% CI, 0.00-0.58; P=0.02). CONCLUSIONS
Our data may provide some evidence of using ARB, but not ACEI, was
associated with a reduced rate of severe illness and ARDS, indicating
their potential protective impact in COVID-19. Further large sample
sizes and multiethnic populations are warranted to confirm our findings.