P189 Use of angiotensin-converting-enzyme inhibitors and angiotensin receptor blockers in COVID-19 infection does not adversely affect clinical outcomes including need for non-invasive and invasive ventilation

Abstract

IntroductionIt has been hypothesized that use of Angiotensin-Converting-Enzyme Inhibitors (ACE-I) and Angiotensin Receptor Blockers (ARB) are associated with worse outcomes in COVID-19 through upregulation of ACE2 receptors.1 Recent studies have shown no association between ACE-I/ARB use and increased mortality but there is limited information on other markers of disease severity such as Continuous Positive Airway Pressure (CPAP) requirement and need for intubation. We assessed the effect of ACE-I/ARB on the outcomes of COVID-19 patients.MethodsA retrospective observational study of patients with suspected or confirmed COVID-19 admitted to the respiratory units during a 1-year period. Patient demographics, clinical and medication history and clinical outcomes were extracted from written and electronic records. Primary outcomes – LOS, CPAP requirement, intensive care (ICU) admission, intubation and death – were compared between those who received ACE-I/ARB concurrently with their COVID-19 treatment and those who did not. Statistical analysis was performed using chi-squared test and odds ratio (OR).ResultsOf 521 patients with suspected or confirmed COVID-19 (median age 59 years, 62.6% male), 183 (35.1%) required CPAP, 108 (20.7%) were admitted to ICU, 60 (11.5%) were intubated and 41 (7.9%) died. In total, 151 (29%) were on ACE-I/ARB treatment, most commonly for hypertension. There was no difference in median LOS between those on ACE-I/ARB treatment and those not (11 and 10 days respectively, p=0.20). There was no difference between CPAP requirement (OR 1.13, 95% CI 0.71–1.56), admission to intensive care (OR 0.64, 95% CI 0.50–1.36), intubation (OR 0.65, 95% CI 0.43–1.58) and death (OR 1.15, 95% CI 0.53–2.11) between the two groups (p>0.05).ConclusionThere was no difference in clinical outcomes between COVID-19 patients on ACE-I/ARB and those who were not, in particular with regards to need for non-invasive and invasive ventilation. Our findings support current recommendations for continued use of ACE-I/ARB in COVID-19 infection.ReferenceFang L, et al. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? The Lancet. Respiratory medicine 2020;8(4):e21. doi:10.1016/S2213-2600(20)30116-8