Beneficial Effects of Angiotensin II Receptor Blockers on Mortality in Patients with COVID-19: A Retrospective Study from 2019 to 2020 in China

Ke Xu; Wu He; Bo Yu; Kaineng Zhong; Da Zhou; Dao Wen Wang

doi:10.1007/s10557-023-07494-5

Beneficial Effects of Angiotensin II Receptor Blockers on Mortality in Patients with COVID-19: A Retrospective Study from 2019 to 2020 in China

Cardiovasc Drugs Ther. 2023 Aug 11. doi: 10.1007/s10557-023-07494-5. Online ahead of print.

Authors

Ke Xu^#¹, Wu He^#¹, Bo Yu¹, Kaineng Zhong², Da Zhou², Dao Wen Wang³

Affiliations

¹ Division of Cardiology, Department of Internal Medicine, Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave., Wuhan, 430030, China.
² Health Commission of Hubei Provincial, Wuhan, 430079, China.
³ Division of Cardiology, Department of Internal Medicine, Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave., Wuhan, 430030, China. dwwang@tjh.tjmu.edu.cn.

^# Contributed equally.

PMID: 37566218
DOI: 10.1007/s10557-023-07494-5

Abstract

Background: The COVID-19 pandemic has become a serious global public health problem. Although the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor type 1 blockers (ARBs) has been recommended in patients with COVID-19 and cardiovascular diseases (CVDs), according to the results of some small-sample retrospective analyses, there remains a lack of sufficient evidence to validate their efficacy. This multicenter retrospective study investigated whether ACEI/ARB administration was beneficial in patients with COVID-19 and CVDs.

Methods: A total of 11,231 patients with confirmed COVID-19 and CVDs, from 138 hospitals in Hubei Province, were included in this multicenter retrospective study. We compared the clinical characteristics and outcomes between the ARB and non-ARB groups and analyzed the risk factors for in-hospital death using univariate and multivariate Cox regression analyses and Kaplan-Meier curves.

Results: In the multivariate Cox regression model, after adjusting for age, gender, comorbidities, and in-hospital medications, ARB use was associated with lower all-cause mortality (adjusted HR, 0.53; 95% CI, 0.38-0.73; P < 0.001). After propensity score-matched analysis, the adjusted HR for the use of ARB associated with all-cause mortality was 0.62 (95% CI, 0.40-0.88; P = 0.02). Further subgroup analyses found that the adjusted HRs for the use of ARB associated with all-cause mortality were 0.52 (95% CI, 0.30-0.89; P = 0.016), 0.37 (95% CI, 0.21-0.64; P < 0.001), 0.42 (95% CI, 0.28-0.64; P < 0.001), and 0.55 (95% CI, 0.37-0.84; P = 0.005) in patients with heart failure, diabetes, and hypercholesterolemia, and severe COVID-19, respectively.

Conclusions: ARB administration was significantly associated with a lower risk of all-cause mortality in patients with COVID-19 and CVDs.

Trial registration: ClinicalTrials.gov NCT05615792. https://www.

Clinicaltrials: gov/ct2/show/NCT05615792.

Keywords: ARB; COVID-19; Cardiovascular diseases; In-hospital mortality; RAAS inhibitor; SARS-CoV-2.

Associated data

ClinicalTrials.gov/NCT05615792