Risk of severe COVID-19 in hypertensive patients treated with renin-angiotensin-aldosterone system inhibitors

Introduction There is controversy concerning the use of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II type-I receptor blockers (ARB) for treating hypertensive patients with Covid-19 It has been hypothesized that these drugs might increase the risk of severe Covid-19, but some authors suggested that blocking the renin-angiotensin system might actually decrease this risk Methods Retrospective cohort study of all the consecutive hypertensive patients with confirmed SARS-CoV-2 infection in a health area The outcome variable was hospitalization because of severe Covid-19 Results 539 subjects were diagnosed of SARS-CoV-2 infection Of these, 157 (29 1%) had hypertension and were included in the study Sixty-nine cases (43 9%) were hospitalized because of severe Covid-19 In multivariable analysis older age, diabetes and hypertensive myocadiopathy were related to a higher risk of hospital admission ARB treatment was associated with a significantly lower risk of hospitalization (HR: 0 29, 95% CI: 0 10 � 0 88) A similar albeit not significant trend was observed for ACEI Conclusion ARB or ACEI treatment was not associated with a worse clinical outcome in consecutive hypertensive patients infected by SARS-CoV-2 Resumen Introducci�n Existe controversia respecto al uso de los inhibidores de la enzima convertidora de angitotensina (iECA) o los bloqueantes de los receptores tipo I de la angiotensina II (ARA-II) para el tratamiento de la hipertensi�n arterial en Covid-19 Se ha sugerido que estos f�rmacos podr�an tanto aumentar como reducir el riesgo de Covid-19 grave Pacientes y m�todo Estudio de cohortes retrospectivo de pacientes consecutivos de un �rea sanitaria, con hipertensi�n e infecci�n por SARS-CoV-2 Variable de resultados: ingreso hospitalario por Covid-19 grave Resultados 539 sujetos fueron diagnosticados de infecci�n por SARS-CoV-2 De estos, 157 (29 1%) eran hipertensos y fueron incluidos en el estudio 69 (43 9%) fueron ingresados por Covid-19 grave En el an�lisis multivariante, la edad m�s elevada, la diabetes y la miocardiopat�a hipertensiva se relacionaron con el riesgo de ingreso hospitalario El tratamiento con ARA-II se asoci� con un riesgo significativamente m�s bajo de ingreso (HR: 0 29, IC 95%: 0 10 � 0 88) Una tendencia similar, aunque no significativa, se encontr� para los iECA Conclusi�n el tratamiento con ARA-II o iECA no se asoci� con una peor evoluci�n cl�nica en pacientes hipertensos consecutivos infectados por SARS-CoV-2