COVID-19 clinical outcomes in patients with and without ongoing therapy with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers

Abstract

Background: The are conflicting reports on the effects of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) continued treatment on clinical outcomes in COVID-19 patients. Material and methods: Patients presented with symptoms suggestive of COVID-19 infection were enrolled between 5 April 2021,and 5 June 2021. Patients who survived acute stage of the disease were asked to attend out-patient clinic after six months following COVID-19 infection diagnosis. Results: A total of 162 patients were enrolled in this study. ARB users showed significant independent association with lower fatality rate as compared to ACEI/ARB-naïve patients [OR (CI) = 0.1(0.0-0.5), p = 0.01]. The prevalence of respiratory support use and intensive care unit (ICU) admission was numerically, but not statically significant, lower among ARB users than non-ARB users. The distribution of in-hospital adverse outcome was numerically lower among ACEI users than in non ACEI users, though the association did not reach statistical significance. ARB users showed significant independent association with persistent cough [OR (CI) = 2 (1.1-10), p = 0.02]. No significant differences in other long term symptoms were found between ARB users and nonusers. On the other hand, chest pain showed higher prevalence among ACEI users than in non-ACEI users. After adjusting for baseline comorbidities, chest pain association with ACEI user was not persisted. No significant differences in other long term symptoms were found between ACEI users and nonusers. Conclusion: ARB and ACEI users showed low prevalence of in-hospital adverse outcome compared to ARB/ACEI nonusers. ARB showed significant and independent association with persistent cough.