Background/Aims: Although it is near concluded that renin-angiotensin system inhibitors do not have a harmful effect on coronavirus disease 2019 (COVID-19), there is no report about whether angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) offer any protective role. This study aimed to compare the association of ARBs and ACEIs with COVID-19-related mortality. Methods: All patients with COVID-19 in Korea between January 19 and April 16, 2020 were enrolled. The association of ARBs and ACEIs with mortality within 60 days were evaluated. A comparison of hazard ratio (HR) was performed between COVID-19 patients and a retrospective cohort of pneumonia patients hospitalized in 2019 in Korea. Results: Among 10,448 COVID-19 patients, ARBs and ACEIs were prescribed in 1,231 (11.7%) and 57 (0.6%) patients, respectively. After adjusting for age, sex, and history of comorbidities, the ARB group showed neutral association (HR, 1.034; 95% CI, 0.765 to 1.399; p = 0.8270) and the ACEI groups showed no significant associations likely owing to the small population size (HR, 0.736; 95% CI, 0.314 to 1.726; p = 0.4810). When comparing HR between COVID-19 patients and a retrospective cohort of patients hospitalized with pneumonia in 2019, the trend of ACEIs showed similar benefits, whereas the protective effect of ARBs observed in the retrospective cohort was absent in COVID-19 patients. Meta-analyses showed significant positive correlation with survival of ACEIs, whereas a neutral association between ARBs and mortality. Conclusions: Although ARBs or ACEIs were not associated with fatal outcomes, potential beneficial effects of ARBs observed in pneumonia were attenuated in COVID-19.
Bibliographical noteFunding Information:
This study was supported by a Research Grant from the Korea Disease Control and Prevention Agency (KDCA) (#4838-330-320-01) and the Seoul National University Hospital (#04-2020-0030).
This was a population-based cohort study supported by the Korea Disease Control and Prevention Agency (KDCA), the National Health Insurance Service (NHIS), and the Korean Society of Hypertension, and was approved by the Institutional Review Board of Seoul National University Hospital (No. 2003-102-1109). Informed consent was waived because the study was based on routinely collected administrative and claims data. All authors reviewed the manuscript for accuracy and completeness of the data.
© 2021 The Korean Association of Internal Medicine.
- Angiotensin receptor antagonists
- Angiotensin-converting enzyme inhibitors