ARBs, ACEIs useful for treating COVID-19 patients with pre-existing hypertension

Angiotensin II receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors (ACEIs) show superiority over other blood pressure (BP)-lowering medications in terms of reducing high-sensitivity C-reactive protein (hs-CRP) and procalcitonin levels in COVID-19 patients with pre-existing hypertension, as shown in a recent study.

The retrospective analysis included 126 hypertensive COVID-19 patients (median age, 66 years; 49.2 percent male) who received treatment with ARBs/ACEIs (n=43) or non-ARBs/ACEIs (n=83) and 125 matched nonhypertensive COVID-19 controls (median age, 66 years; 48.8 percent male). Researchers also reviewed the medication history of 1,942 hypertensive patients (non-COVID-19) hospitalized prior to the outbreak for external comparison.

Compared with controls, hypertensive patients had higher levels of systolic and diastolic blood pressure (125/75 vs 120/70 mm Hg; p=0.031 and p=0.004, respectively) and were more likely to have diabetes (30.2 percent vs 13.6 percent; p=0.002) and cardiopathy (18.3 percent vs 9.6 percent; p=0.048).

Of note, the frequency of ARBs/ACEIs usage was similar in hypertensive patients with and without COVID-19 (34.1 percent vs 35.4 percent; p=0.767).

In the group of COVID-19 patients with hypertension, BP did not significantly differ between those who received ARBs/ACEIs and those on non-ARBs/ACEIs. However, treatment with ARBs/ACEIs was associated with significantly lower concentrations of hs-CRP (p=0.049) and procalcitonin (p=0.008), as well as numerically fewer critically ill patients (9.3 percent vs 22.9 percent; p=0.061) and a lower number of deaths (4.7 percent vs 13.3 percent; p=0.216).

The present data support the use of ARBs/ACEIs over other antihypertensive drugs in the treatment of COVID-19 patients with hypertension, researchers said. Large prospective studies are needed to validate the results and to explore the mechanisms by which ARBs/ACEIs regulate the inflammatory response.