Association of inpatient use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers with mortality among patients with hypertension hospitalized with COVID-19
Open accessAbstract
Rationale: Use of ACEIs (angiotensin-converting enzyme inhibitors) and ARBs (angiotensin II receptor blockers) is a major concern for clinicians treating coronavirus disease 2019 (COVID-19) in patients with hypertension. Objective: To determine the association between in-hospital use of ACEI/ARB and all-cause mortality in patients with hypertension and hospitalized due to COVID-19. Methods and Results: This retrospective, multi-center study included 1128 adult patients with hypertension diagnosed with COVID-19, including 188 taking ACEI/ARB (ACEI/ARB group; median age 64 [interquartile range, 55–68] years; 53.2% men) and 940 without using ACEI/ARB (non-ACEI/ARB group; median age 64 [interquartile range 57–69]; 53.5% men), who were admitted to 9 hospitals in Hubei Province, China from December 31, 2019 to February 20, 2020. In mixed-effect Cox model treating site as a random effect, after adjusting for age, gender, comorbidities, and in-hospital medications, the detected risk for all-cause mortality was lower in the ACEI/ARB group versus the non-ACEI/ARB group (adjusted hazard ratio, 0.42 [95% CI, 0.19–0.92]; P =0.03). In a propensity score-matched analysis followed by adjusting imbalanced variables in mixed-effect Cox model, the results consistently demonstrated lower risk of COVID-19 mortality in patients who received ACEI/ARB versus those who did not receive ACEI/ARB (adjusted hazard ratio, 0.37 [95% CI, 0.15–0.89]; P =0.03). Further subgroup propensity score-matched analysis indicated that, compared with use of other antihypertensive drugs, ACEI/ARB was also associated with decreased mortality (adjusted hazard ratio, 0.30 [95% CI, 0.12–0.70]; P =0.01) in patients with COVID-19 and coexisting hypertension. Conclusions: Among hospitalized patients with COVID-19 and coexisting hypertension, inpatient use of ACEI/ARB was associated with lower risk of all-cause mortality compared with ACEI/ARB nonusers. While study interpretation needs to consider the potential for residual confounders, it is unlikely that in-hospital use of ACEI/ARB was associated with an increased mortality risk.
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AngII-AT1R axis inhibitors may be beneficial for COVID-19 patients to decrease serum IL-6 levels.
“Consistent with animal models, it was reported that AngII–AT1R axis inhibitors may be beneficial for COVID-19 patients (360–363) to decrease serum IL-6 levels (360).”
From IL-6 in inflammation, autoimmunity and cancer (2021) · cites this paper as [361]
The Results (Primary Outcomes; page unavailable) associate inpatient ACEI/ARB use with lower mortality among patients with hypertension hospitalized with COVID-19, supporting the possibility of benefit. But our copy does not report that these drugs decrease serum IL-6 levels; searches for “IL-6” and “interleukin-6” found no such finding. (LLM, conf=0.88)
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COVID-19 and its cardiovascular effects: a systematic review of prevalence studies
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Risks of ACE Inhibitor and ARB Usage in COVID‐19: Evaluating the Evidence
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Approach to Acute Cardiovascular Complications in COVID-19 Infection
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SARS-CoV-2 and cardiovascular complications: From molecular mechanisms to pharmaceutical management
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Inhibitors of the Renin–Angiotensin–Aldosterone System and Covid-19
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Kidney Function Indicators Predict Adverse Outcomes of COVID-19
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Are we equal in adversity? Does Covid-19 affect women and men differently?
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Statins: Could an old friend help in the fight against COVID‐19?
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COVID-19: from epidemiology to treatment
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- Authors
- Zhang, P., Zhu, L., Cai, J., Lei, F., Qin, J.-J., Xie, J., Liu, Y.-M., Zhao, Y.-C., Huang, X., Lin, L., Xia, M., Chen, M.-M., Cheng, X., Zhang, X., Guo, D., Peng, Y., Ji, Y.-X., Chen, J., She, Z.-G., Wang, Y., Xu, Q., Tan, R., Wang, H., Lin, J., Luo, P., Fu, S., Cai, H., Ye, P., Xiao, B., Mao, W., Liu, L., Yan, Y., Liu, M., Chen, M., Zhang, X.-J., Wang, X., Touyz, R. M., Xia, J., Zhang, B.-H., Huang, X., Yuan, Y., Loomba, R., Liu, P. P., & Li, H.
- Affiliations
- Wuhan University (CN)
- Central South University (CN)
- Renmin Hospital of Wuhan University (CN)
- Institute of Model Animal of Wuhan University (P.Z., L.Z., F.L., J.-J.Q., Y.-M.L., Y.-C.Z., X. Huang, L. Lin, M.X., M.-M.C., X.C., Y.-X.J., J. Chen, Z.-G.S., X.-J.Z., H.L.)
- From the Cardiology (P.Z., L.Z., J.-J.Q., J. Xie, Y.-M.L., Y.-C.Z., X. Huang, M.-M.C., X.C., Z.-G.S., X.-J.Z., H.L.), Renmin Hospital of Wuhan University
- Zhongnan Hospital of Wuhan University (CN)
- University of California, Los Angeles (US)
- Queen Mary University of London (GB)
- Wuhan Kanghuashuhai Technology Company (R.T.), Wuhan
- Wuhan Ninth Hospital (H.C., M.L.)
- Central Hospital of Wuhan (CN)
- Stomatology, Xiantao First People’s Hospital (B.X.)
- Huanggang Central Hospital (CN)
- Ezhou Central Hospital (CN)
- Wuhan No. 7 Hospital (CN)
- University of Glasgow (GB)
- Huazhong University of Science and Technology (CN)
- Neonatology (B.-H.Z.), Renmin Hospital of Wuhan University
- University of California San Diego (US)
- Ottawa Heart Institute (CA)
- Corresponding author
- Zhang, Peng
- Zhu, Lihua
- Cai, Jingjing
- Lei, Fang
- Qin, Juan-Juan
- ORCID
- Zhang, Peng
- Zhu, Lihua
- Cai, Jingjing
- Lei, Fang
- Qin, Juan-Juan
- Xie, Jing
- Huang, Xuewei
- Lin, Lijin
- Cheng, Xu
- Zhang, Xiao
- Guo, Deliang
- Peng, Yuanyuan
- Ji, Yan-Xiao
- Chen, Jing
- She, Zhi-Gang
- Wang, Yibin
- Xu, Qingbo
- Wang, Haitao
- Lin, Jun
- Luo, Pengcheng
- Fu, Shouzhi
- Cai, Hongbin
- Ye, Ping
- Xiao, Bing
- Liu, Mingyu
- Chen, Manhua
- Zhang, Xiao-Jing
- Wang, Xinghuan
- Touyz, Rhian M.
- Xia, Jiahong
- Huang, Xiaodong
- Yuan, Yufeng
- Loomba, Rohit
- Liu, Peter P.
- Li, Hongliang
- Venue
- Circulation Research
- Published
- 2020-06-05
- Volume
- 126
- Issue
- 12
- Pages
- 1671-1681
- ISSN
- 0009-7330 (ISSN-L)
- 1524-4571
- PMC
- PMC7265882
- OpenAlex
- W3016572296
- Cited by
- 1,133
- References
- 32
- Citations by year
- 2026: 6 · 2025: 16 · 2024: 47 · 2023: 81 · 2022: 120 · 2021: 324 · 2020: 537 · 2019: 1
- FWCI
- 34.87
- Type
- journal article
- Language
- en
- Update notices
- correction (2020-08-27)
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- Circulation Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Funders
- National Key R&D program of China (2016YFF0101504, 2020YFC0845500)
- National Science Foundation of China (81630011; 81970364;81970070;81970011;81870171; 81700356)
- Major Research Plan of the National Natural Science Foundation of China (91639304)
- Hubei Science and Technology Support Project (2019BFC582; 2018BEC473; 2017BEC001)
- Medical flight plan of Wuhan University
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
- Keywords
- COVID-19 pandemic, hypertension, ACE inhibitors, angiotensin receptor blockers, all-cause mortality, antihypertensive drugs, hospitalized patients, SARS-CoV-2, 2020 outbreak, propensity score matching
- MeSH terms
- COVID-19, Aged, Angiotensin-Converting Enzyme Inhibitors, Female, Humans, Hypertension, Inpatients, Male, Middle Aged, Pneumonia, Viral, Hospital Mortality, Coronavirus Infections, Angiotensin Receptor Antagonists, Pandemics
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