Angiotensin converting enzymes inhibitors or angiotensin receptor blockers should be continued in COVID-19 patients with hypertension

doi:10.12998/wjcc.v9.i1.47

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World Journal of Clinical Cases

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World J Clin Cases. Jan 6, 2021; 9(1): 47-60
Published online Jan 6, 2021. doi: 10.12998/wjcc.v9.i1.47

Angiotensin converting enzymes inhibitors or angiotensin receptor blockers should be continued in COVID-19 patients with hypertension

Ci Tian, Nan Li, Yi Bai, Han Xiao, Shu Li, Qing-Gang Ge, Ning Shen, Qing-Bian Ma

Ci Tian, Yi Bai, Shu Li, Qing-Bian Ma, Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China

Nan Li, Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China

Han Xiao, Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing 100191, China

Qing-Gang Ge, Department of Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China

Ning Shen, Department of Pulmonary and Critical Care Medicine, Department of Medicine, Peking University Third Hospital, Beijing 100191, China

Author contributions: Tian C conceived and designed the study; Tian C and Bai Y collected the data of this study; Li N performed the data analysis; Tian C wrote the manuscript; Li S reviewed and edited the manuscript; Ma QB designed research; all authors read and approved the manuscript. Tian C, Li N and Bai Y contributed equally to the manuscript.

Institutional review board statement: This study was approved by Institutional Review Board of Peking University Third Hospital, China (No. IRB00006761-M2020060).

Informed consent statement: The study was approved by Institutional Review Board of Peking University Third Hospital and got waiver of written informed consent.

Conflict-of-interest statement: The authors declare that there is no conflict of interest.

Data sharing statement: The data used to support the findings of this study are available from the corresponding author upon request.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Corresponding author: Qing-Bian Ma, MD, Associate Professor, Chairman, Chief Physician, Department of Emergency Medicine, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China. maqingbian@bjmu.edu.cn

Received: October 9, 2020
Peer-review started: October 9, 2020
First decision: November 3, 2020
Revised: November 9, 2020
Accepted: November 21, 2020
Article in press: November 21, 2020
Published online: January 6, 2021
Processing time: 84 Days and 3.3 Hours

Abstract

BACKGROUND

Recent studies have revealed that sustained ingestion of angiotensin converting enzymes inhibitors or angiotensin receptor blockers (ACEIs/ARBs) had no harmful effects on coronavirus disease 2019 (COVID-19) patients complicated with hypertension.

AIM

To investigate the impact on COVID-19 patients complicated with hypertension who discontinued using ACEIs/ARBs.

METHODS

All COVID-19 patients complicated with hypertension admitted to our isolated unit were consecutively recruited in this study. Some patients switched from ACEIs/ARBs to calcium channel blocker (CCBs) after admission, while others continued using non-ACEIs/ARBs. We compared characteristics and clinical outcomes between these two groups of patients.

RESULTS

A total of 53 patients were enrolled, 27 patients switched from ACEIs/ARBs to CCBs while 26 patients continued with non-ACEIs/ARBs. After controlling potential confounding factors using the Cox proportional hazards model, hospital stay was longer in patients who discontinued ACEIs/ARBs, with a hazard ratio of 0.424 (95% confidence interval: 0.187-0.962; P = 0.040), upon discharge than patients using other anti-hypertensive drugs. A sub-group analysis showed that the effect of discontinuing use of ACEIs/ARBs was stronger in moderate cases [hazard ratio = 0.224 (95% confidence interval: 0.005-0.998; P = 0.0497)].

CONCLUSION

Patients in the discontinued ACEIs/ARBs group had longer hospital stays. Our findings suggest that COVID-19 patients complicated with hypertension should continue to use ACEIs/ARBs.

Keywords: COVID-19; Hypertension; Angiotensin converting enzymes inhibitors; Angiotensin receptor blockers; Angiotensin-converting enzyme-2; Prognosis

Core Tip: Recent research revealed that use of angiotensin converting enzymes inhibitors or angiotensin receptor blockers (ACEIs/ARBs) had no significant harm on coronavirus disease 2019 (COVID-19) patients complicated with hypertension. However, the impact of discontinue using ACEIs/ARBs in those patients was still unclear. In the present study, we retrospectively collected the clinical data of patients with both COVID-19 and hypertension to explore whether any difference in disease outcomes existed between patients who discontinued using ACEIs/ARBs and those who continued using other anti-hypertensive drugs.