Med Bull Sisli Etfal Hosp. 2020; 54(4): 399-404 | DOI: 10.14744/SEMB.2020.15689

The Association between Chronic Use of Renin–Angiotensin-Aldosterone System Blockers and in-Hospital Adverse Events among COVID-19 Patients with Hypertension

Gokhan Cetinkal¹, Betul Balaban Kocas¹, Ozgur Selim Ser¹, Hakan Kilci¹, Suleyman Sezai Yildiz¹, Safiye Nur Celebi², Yildiz Verdi², Mustafa Altinay³, Kadriye Kilickesmez^1
1Department of Cardiology, University of Health Sciences Turkey, Sisli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Turkey
²Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Turkey, Sisli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Turkey
³Sisli Hamidiye Etfal Education and Research Hospital, Department of Anesthesiology and Reanimation

Objectives: The effects of chronic renin–angiotensin–aldosterone system (RAAS) blockers usage on adverse outcomes and disease severity remain uncertain in COVID-19 patients with hypertension. In this study, we aimed to determine the relationship between chronic use of RAAS inhibitors and in-hospital adverse events among hypertensive patients hospitalized with COVID-19.
Methods: In this retrospective single-center study, we enrolled 349 consecutive hypertensive patients diagnosed with COVID-19 infection. All patients were chronically on angiotensin-converting enzyme inhibitors (ACEI)/ angiotensin II receptor blockers (ARB) or other antihypertensive therapies before hospital admission. Adverse clinical events were defined as in-hospital mortality, admission to intensive care unit, need for high-flow oxygen and intubation.
Results: Patients were categorized into two groups according to the type of antihypertensive therapy. (ACEI/ARBs users, N=201; ACEI/ARB nonusers, N=148) There was no statistically significant difference between ACEI/ARBs users and ACEI/ARBs nonusers concerning adverse clinical events, such as in-hospital mortality (29 (14.4%) vs. 20 (13.5%), p=0.81), ICU admission (45(22.4%) vs. 27 (18.2%), p=0.34), need for high-flow oxygen (97 (48.3%) vs. 68 (45.9%), p=0.67) and need for intubation (32(15.9%) vs. 23(15.5%), p=0.92), respectively. Also, the severity of infection did not differ among groups. The logistic regression multivariate analysis showed that age, neutrophil-lymphocyte ratio, procalcitonin and ferritin levels were independent predictors of in-hospital mortality.
Conclusion: Our results suggest that chronic use of ACEI/ARBs did not increase in-hospital adverse outcomes of hypertensive patients hospitalized with COVID-19. Although the recent data are contradictory, chronic ACEI/ARB therapy is not recommended to be discontinued in hypertensive patients during their hospitalization for COVID-19.

Keywords: COVID-19, hypertension; RAAS blockers; mortality; adverse clinical outcomes.

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Hipertansiyon Tanýlý COVID-19 Hastalarýnda Kronik Renin-Anjiotensin-Aldosteron Sistem Blokerleri Kullanýmý ile Hastane Ýçi Ýstenmeyen Olaylar Arasýndaki Ýliþki

Gokhan Cetinkal¹, Betul Balaban Kocas¹, Ozgur Selim Ser¹, Hakan Kilci¹, Suleyman Sezai Yildiz¹, Safiye Nur Celebi², Yildiz Verdi², Mustafa Altinay³, Kadriye Kilickesmez^1
1Saðlýk Bilimleri Üniversitesi, Þiþli Hamidiye Etfal Eðitim ve Araþtýrma Hastanesi, Kardiyoloji Anabilim Dalý, Ýstanbul
²Saðlýk Bilimleri Üniversitesi, Þiþli Hamidiye Etfal Eðitim ve Araþtýrma Hastanesi, Bulaþýcý Hastalýklar ve Klinik Mikrobiyoloji Anabilim Dalý, Ýstanbul
³Saðlýk Bilimleri Üniversitesi Þiþli Hamidiye Etfal Eðitim ve Araþtýrma Hastanesi, Anesteziyoloji ve Reanimasyon Anabilim Dalý, Ýstanbul

Amaç: Hipertansiyon tanýsý olan COVID-19 hastalarýnýn kronik renin-anjiyotensin-aldosteron sistemi (RAAS) blokeri kullanýmýnýn hastane içi istenmeyen olaylar ve hastalýðýn ciddiyeti üzerine etkisi halen belirsizliðini korumaktadýr. Bu çalýþmada COVID-19 nedeni ile hastanede yatan hipertansif hastalarda RAAS inhibitörlerinin kronik kullanýmý ile hastane içi advers olaylar arasýndaki iliþkiyi belirlemeyi amaçladýk.
Yöntem: Bu tek merkezli ve retrospektif çalýþmaya COVID-19 tanýsý konmuþ 349 hipertansif hastayý dahil ettik. Bütün hastalar hastane yatýþý öncesinde kronik olarak anjiotensin dönüþtürücü enzim inhibitörü (ADEI)/anjiotensin II reseptör blokeri (ARB) veya diðer antihipertansif tedavileri alýyordu. Ýstenmeyen klinik olaylar; hastane içi ölüm, yoðun bakýma gidiþ,yüksek akým oksijen ihtiyacý ve entübasyon olarak belirlendi.
Bulgular: Hastalar antihipertansif tedavi tipine göre iki gruba ayrýldý. (ADEI/ARB kullananlar, n=201; ADEI/ARB kullanmayanlar n=148). ADEI/ARB kullananlarla kullanmayanlar arasýnda hastane içi ölüm (29(14.4%) vs 20(13.5%), p=0.81), yoðun bakýma gidiþ (45(22.4%) vs 27(18.2%), p=0.34), yüksek akým oksijen ihtiyacý (97(48.3%) vs 68 (45.9%), p=0.67) ve entübasyon (32(15.9%) vs 23(15.5%),p=0.92) gibi hastane içi istenmeyen olaylar açýsýndan istatistiksel olarak anlamlý farklýlýk yoktu. Ayrýca enfekfsiyon þiddeti de gruplar arasýnda benzerdi. Lojistik regresyon analizinde yaþ, nötrofil/lenfosit oraný, prokalsitonin ve ferritin düzeyleri hastane içi ölüm için baðýmsiz ön gördürücüler olarak saptandý.
Sonuç: Sonuçlarýmýz COVID-19 nedeniyle hastanede yatan hipertansif hastalarda kronik ADEI/ARB kullanýmýnýn hastane içi istenmeyen olay sýklýðýný artýrmadýðýný düþündürmektedir. Son dönemde yapýlan çalýþmalarýn sonuçlarý çeliþkili olsa da; hipertansiyonu olan COVID-19 hastalarýnýn hastane yatýþý boyunca kronik ADEI/ARB kullanýmýnýn kesilmesi önerilmemektedir. (SETB-2020-09-159)

Anahtar Kelimeler: COVID-19, hipertansiyon, RAS bloklerleri, mortalite, istenmeyen klinik olaylar

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