ACEI/ARBs fight off confusion among hypertensive COVID-19 patients

The use of angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II type-1 receptor blockers (ARBs) seem to protect against confusion in patients of the novel coronavirus disease (COVID-19) with hypertension, a recent Japan study has found.

The study included 151 COVID-19 patients, of whom 39 were hypertensive (mean age, 71±12 years; 69.2 percent male). The primary outcome was a composite of in-hospital death, extracorporeal membrane oxygenation, invasive and noninvasive mechanical ventilation, and admission into the intensive care unit (ICU). Outcomes were compared to 112 patients without hypertension (mean age, 56±20 years; 56.3 percent male).

Of the 39 hypertensive participants, 22 were on ACEI/ARB medication. Fourteen in-hospital deaths were recorded, yielding an overall rate of 9.3 percent. Fourteen and 58 patients required mechanical ventilation or oxygen therapy, respectively.

Multivariate logistic regression analyses showed that age was the strongest and most consistent risk factor for all outcomes assessed. Participants ≥65 years of age, for example, saw a sixfold spike in the likelihood of the primary composite outcome occurring (odds ratio [OR], 6.63, 95 percent confidence interval [CI], 2.28–22.78; p<0.001).

Similarly, these patients were more than four times as likely to develop the secondary composite endpoint (OR, 4.53, 95 percent CI, 1.72–13.20; p=0.002), which included low admission systolic blood pressure and new-onset or worsening mental confusion, among others.

Notably, while ACEI/ARB use had no significant benefit with regard to the primary and secondary composite outcomes, it exerted a significant protective effect against new-onset confusion, reducing the odds by nearly 90 percent (OR, 0.13, 95 percent CI, 0.01–0.93; p=0.041).