Angiotensin receptor blocker may improve outcomes in nonobese COVID-19 patients

Use of the angiotensin receptor blocker (ARB) candesartan appears to confer benefits for length of hospital stay, radiological outcome, and time-to-negative swab in the subgroup of nonobese patients with COVID-19, according to a study.

The study was conducted in the early months of COVID-19 pandemic and included 75 ARB-naïve patients with COVID-19, none of whom received intensive care unit (ICU) care. A total of 35 patients received candesartan (mean age 41 years, 70.67 male, mean body mass index 23.35 kg/m²), of whom 9.3 percent were hypertensive, 5.3 percent were diabetic, 12 percent were current smokers, and 89.33 percent were clinical mild–moderate cases while 10.67 percent were severe cases.

Candesartan was administered at 4 mg to 32 mg once daily, titrated according to blood pressure tolerance. Treatment was postponed if systolic blood pressure (SBP) fell below 90 mm Hg and restarted when the SBP was above 100 mm Hg.

All patients received the control treatment regimen comprising azithromycin 500 mg once daily or levofloxacin IV 750 mg once daily, hydrochloroquine 400 mg once daily, and intravenous vitamin C 1,000 mg, along with symptomatic medications and additional antibiotics based on physician’s discretion.

Compared with the control group, the candesartan group had a markedly shorter hospital stay (adjusted hazard ratio [HR], 2.47, 95 percent confidence interval [CI], 1.16–5.29) with no heightened risk of intensive care.

In the subgroup of nonobese patients, a negative swab occurred sooner among patients who received candesartan vs control treatment only (adjusted HR, 2.40, 95 percent CI, 1.08–5.09), as was improvement in chest X-ray (adjusted HR, 2.82, 95 percent CI, 1.13–7.03).