Prior use of BP-lowering drugs reduces death in older hypertensive COVID-19 patients

Antecedent use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) among older COVID-19 patients with hypertension results in fewer all-cause deaths, whether in-hospital or shortly after discharge, compared with no antecedent use of renin-angiotensin system inhibitors (RASIs), a study has shown.

The investigators selected and analysed hypertensive patients from a cohort of 1,352 consecutive patients admitted with COVID-19 to Papa Giovanni XXIII Hospital in Bergamo, Italy, between February and April 2020, to determine whether antecedent (prior to hospitalization) use of RASIs could influence mortality from COVID-19 according to age.

Of the patients, 688 presented with arterial hypertension, and 240 died either in-hospital or shortly following discharge, with an overall mortality rate of 35 percent.

After adjusting for 26 medical history variables via propensity score matching, antecedent use of RASIs (n=459, 67 percent) correlated with a lower mortality in older hypertensive patients (aged >68 years), but not in the younger group of the same population (p_interaction=0.001).

The investigators then performed a subgroup analysis of 432 hypertensive patients older than 68 years, which considered two RASI drug subclasses (ACEIs, n=156; ARBs, n=140) and examined their respective effects by taking no antecedent use of RASIs as the reference.

Antecedent use of ACEIs or ARBs was found to be associated with lower mortality from COVID-19 (ACEI: odds ratio [OR], 0.57, 95 percent confidence interval [CI], 0.36‒0.91; p=0.018; ARB: OR, 0.49, 95 percent CI, 0.29‒0.82; p=0.006).