- retrospective, multi-center study that included 1128 patients with hypertension diagnosed with COVID-19
- of the 1128 patients, 188 were taking ACEI/ARBs
- after adjustment for age, gender, comorbidities and in-hospital medications, the risk for mortality was found to be lower in the ACEI/ARB group vs those who weren't taking any ACEI/ARBs
- subgroup propensity score-matched analyses revealed that ACEI/ARBs were more associated with lower mortality compared to other antihypertensive drugs
- limitations of the study include the need to consider other confounding variables

Association study between the use of RAS inhibitors with mortality among patients with hypertension hospitalized with COVID-19

- retrospective, observational study of all patients admitted with COVID-19 to Huo Shen Shan Hospital
- of the 2877 patients, 29.5% had a history of hypertension
- after adjustment for confounding variables, patients with hypertension had a two-fold increase in relative risk of mortality
- hypertensive patients without antihypertensive treatments were also at higher risk of mortality
- in a study-level meta-analysis of four studies, results showed that patients with RAS inhibitors tended to have lower risk of mortality

Observational study of hypertension and antihypertensive treatment with COVID-19 mortality

- study sample consisted of 614 hypertensive COVID-19 patients during hospitalization
- demographics, comorbidities, vital signs, lab data, and ACEi/ARB usage were analyzed
- mortality and ICU rates were not significantly different between RAS inhibitor users and non-users
- patients who continued ACEi/ARBs in hospital had lower ICU admission and mortality rates

Association study between continued use of RAS inhibitors with clinical outcome

- study reviewed clinical data from medical records of COVID-19 positive hypertensive patients after receiving verbal consent from all patients or patients' family members
- 42 hypertensive patients on antihypertensive therapies of which 17 were on RAS inhibitors and 25 were on other antihypertensive drugs
- ACEI/ARB therapy reduced the inflammatory response, potentially through inhibition of IL-6 levels
- ACEI/ARB therapy also avoided peripheral T cell depletion
- a decrease in viral load from ACEI/ARB therapy was observed but it is hypothesized that RAS inhibitors play an antiviral role by regulating immune function and inhibiting inflammatory responses

RAS inhibitors improve clinical outcomes of COVID-19 patients with hypertension

- Association study between the use of RAS inhibitors with mortality among patients with hypertension hospitalized with COVID-19
- Observational study of hypertension and antihypertensive treatment with COVID-19 mortality
- Association study between continued use of RAS inhibitors with clinical outcome
- RAS inhibitors improve clinical outcomes of COVID-19 patients with hypertension

State University of New York at Stony Brook

Some believe that ACE-I/ARB use is beneficial in treating SARS-CoV-2 infections beneficial because the relative amount of Ang II is decreased.  While ACE2 expression may increase, the anti-inflammatory and anti-oxidant properties of Ang II could be helpful in mitigating or preventing acute lung injury.  

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