Is prior use of renin-angiotensin system (RAS) inhibitors associated with more favourable outcome in COVID-19 hospitalized patients?

Mohammad-Mehdi  Mehrabi Nejad; Hamed Bagheri; Seyyed Hosein Mousavi; Faeze Salahshour; Niloofar Ayoobi Yazdi; Babak Shekarchi

doi:10.18502/fem.v6i3.9396

Mohammad-Mehdi Mehrabi Nejad Department of Radiology, School of Medicine, AJA University of Medical Science, Tehran, Iran
Hamed Bagheri Student Research Committee, AJA University of Medical Sciences, Tehran, Iran
Seyyed Hosein Mousavi Department of Cardiology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
Faeze Salahshour Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
Niloofar Ayoobi Yazdi Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
Babak Shekarchi Department of Radiology, School of Medicine, AJA University of Medical Science, Tehran, Iran

DOI: https://doi.org/10.18502/fem.v6i3.9396

Keywords: Angiotensin-Converting Enzyme Inhibitors; Angiotensin Receptor Antagonists; COVID-19; Hypertension; Patient Outcome Assessment; X-Ray Computed Tomography

Abstract

Objective: We aimed to investigate the extent of pulmonary involvement and adverse outcomes in patients receiving angiotensin-converting enzyme inhibitor (ACEI)/ angiotensin II receptor blocker (ARB) versus who did not, in hospitalized coronavirus infectious disease 2019 (COVID-19) patients.

Methods: All COVID-19 patients with a positive polymerase chain reaction (PCR) test, who were admitted to our tertiary referral hospitals in Tehran, Iran between January 2021 and May 2021, and had an on-admission chest computed tomography (CT) scan, were included. The patients were divided into two groups (receiving ACEI/ARB and who did not) for further analysis. The outcomes of interest in our study were the extent of pulmonary involvement, intensive care unit (ICU) admission, and death.

Results: A total of 893 participants (mean age of 58.6±15.4 years; female, 522 (58.4%)) were enrolled. Among them, 368 (41.2%) participants had hypertension, and use of ACEI/ARB was reported in 183 (20.5%) participants. Of all, 409 (45.8%) participants required ICU admission, and 259 (29%) participants succumbed to death. We found that participants who received ACEI/ARB were less likely to progress critical disease and experienced significantly lower ICU admission (P=0.022) and death (P<0.001). On multivariable analysis adjusting for age, sex, and comorbidities, this relationship remained statistically significant for death (odds ratio (OR): 0.23 [0.14-0.38], P<0.001) and ICU admission (OR: 0.49 [0.32-0.73], P=0.001).

Conclusion: Our findings showed that COVID-19 patients who receiving ACEI/ARB prior to hospitalization vs. those who did not, had more favorable outcomes.