Background and importance Identification of the angiotensin converting enzyme (ACE2) as a target of the SARS-CoV-2 virus raises questions about a possible change in the clinical course of this infection associated with inhibitors of the renin–angiotensin–aldosterone system (RAAS). Furthermore, high blood pressure is considered a risk factor for COVID-19.
Aim and objectives To characterise the clinical course in hypertensive patients admitted for COVID-19 and to determine if treatment with RAAS inhibitors, age and additional comorbidities may be related to mortality and development of acute respiratory distress syndrome (ARDS).
Material and methods A single centre, observational, retrospective study was conducted. Inclusion criteria were: diagnosis of hypertension, hospital admission for COVID-19 between 1 March and 24 March 2020. Demographic, clinical and analytical variables were recorded. Clinical course was evaluated by: development of bilateral pneumonia, ARDS, length of stay and mortality. End of follow-up was 10 October 2020. To evaluate the possible influence of factors on evolution, binary logistic regression was performed using the STATA-IC14 programme. Quantitative dependent variables were transformed into dichotomous variables. Statistical significance was defined as p<0.05.
Results 571 patients were analysed, with a median age of 76 years (IQR 66–83) and 59.2% were men. Of these, 69.7% were receiving treatment with RAAS inhibitors, 7.2% smoked and 80.0% had additional comorbidities. At hospital admission, 27.3% presented with hypoxaemia (SatO2<90%), 64.3% lymphopenia (<1000/mm3), 18.8% C reactive protein >20 mg/dL and 11.7% D-dimer >1200 ng/mL. During the hospital stay, 91.9% of patients required oxygen therapy, 76.4% developed bilateral pneumonia, 91.9% required oxygen therapy, 47.5% developed ARDS and 33.6% died. Median hospital stay was 15 days (IQR 9–24). Use of RAAS inhibitors was not linked to changes in mortality or development of ARDS (p>0.05).
Risk factors associated with mortality were: additional cardiovascular diseases (OR=2.10; p=0.000) and older age (OR=1.05; p=0.000). Regarding ARDS, we found an association with obesity (OR=1.77; p=0.013), diabetes mellitus (OR=1.84; p=0.001) and age (OR=1.02; p=0.010). Hospital stay >14 days was significantly longer in advanced age (OR=1.02; p=0.022) and if chronic kidney disease was present (OR=1.73, p=0.043).
Conclusion and relevance Antihypertensive treatment with RAAS inhibitors did not seem to be linked to the risk of worse evolution of COVID-19. Advanced age and additional cardiovascular disease appeared to be associated with higher mortality in hypertensive patients.
References and/or acknowledgements
Angel-Korman A, et al. COVID-19, the kidney and hypertension. Harefua 2020;159:231–4. https://pubmed.ncbi.nlm.nih.gov/32307955/
Conflict of interest No conflict of interest
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