J Am Heart Assoc. 2020 Oct 7:e017364. doi: 10.1161/JAHA.120.017364. Online ahead of print.
Background SARS-CoV-2 (COVID-19) utilizes the angiotensin converting enzyme-2 (ACE-2) receptor to enter human cells. Angiotensin converting enzyme inhibitors (ACEI) and angiotensin II receptor antagonists (ARB) are associated with ACE-2 upregulation. We hypothesized that antecedent use of ACEI/ARB may be associated with mortality in COVID-19. Methods and Results We used the Coracle registry, which contains data of hospitalized COVID-19 patients in 4 regions of Italy, and restricted analyses to those ≥ 50 years of age. The primary outcome was in-hospital mortality. Among these 781 acutely ill patients, 133 (17.0%) used an ARB and 171 (21.9%) used an ACEI. While neither sex nor smoking status differed by user groups, patients on ACEI/ARB tended to be older and more likely to have hypertension, diabetes mellitus, and congestive heart failure. The overall mortality rate was 15.1% (118/781) and increased with age (PTrend < 0.0001). The crude odds ratios (ORs) for death for ACEI users and ARB users were 0.98, 95% confidence interval (CI): 0.60-1.60, p=0.9333, and 1.13, 95% CI: 0.67-1.91, p=0.6385, respectively. After adjusting for age, hypertension, diabetes mellitus, and congestive heart failure, antecedent ACEI administration was associated with reduced mortality (OR: 0.55, 95% CI: 0.31-0.98, p=0.0436); a similar, but weaker trend was observed for ARB administration (OR: 0.58, 95% CI: 0.32-1.07, p=0.0796). Conclusions In those aged ≥50 years hospitalized with COVID-19, antecedent use of ACEI was independently associated with reduced risk of inpatient death. Our findings suggest the protective role of renin-angiotensin-aldosterone system inhibition in patients with high cardiovascular risk affected by COVID-19.