68. ASSOCIATION OF RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM BLOCKER DRUGS AND OUTCOMES IN COVID-19 PATIENTS WITH HYPERTENSION

Abstract

Background: The role of renin-angiotensin-aldosterone system (RAAS) blockers during the coronavirus disease 2019 (COVID-19) pandemic is a matter of controversies. Studies based on in-hospital exposure have suggested a beneficial effect of these drugs, unlike those based on chronic exposure. Objective: To analyse RAAS blocker prescription before and during hospital stay and clinical outcomes in patients with COVID-19. The primary outcome was in-hospital mortality within 30 days of admission. The secondary outcome was a severe disease defined as the need for high flow nasal cannula (HFNC), ICU admission, or death, within 30 days of admission. Methods: A retrospective cohort study was conducted in 112 hypertensive patients hospitalized for COVID-19 during March until December 2020. The association between exposure and outcomes within hospitalization was analysed using logistic regression analysis. Results: Of 112 patients, mean age was 56.33 ± 12.9 years, 61 (54.5%) were male, with mean Systolic BP was 147 ± 25.4 and mean Diastolic BP was 86.6 ± 14.2 mmHg in all groups. There were 86 (76.7%) patients had prior use of RAAS blocker at admission. Baseline characteristics showed significant difference on peripheral SpO2 saturation at admission between prior use and without prior use of RAAS blockers groups, 96.8 ± 3.5% vs 94 ± 9.13%, p = 0.046, and use of Ca channel blocker drugs 65 (75.6%) vs 14 (53.8%), p = 0.03, respectively. Overall mortality was 22 (19.6%) in both groups. Among patients with prior exposure to RAAS blockers, 20.9% died within 30 days of admission versus 15.4% in patients without prior exposure to RAAS blockers [OR 1.28 (95% CI, 0.39–4.23), p = 0.67] and 25.6% patients suffered severe disease vs 26.9% in patients without prior exposure to RAAS blockers [OR 0.12 (95% CI, 0.01–0.74), p = 0.02]. Conclusions: Mortality was found higher in patients with prior exposure to RAAS blockers than in patients without prior exposure to RAAS blockers. There was no significant association between RAAS drugs exposure and mortality in COVID-19 patients, but patients with no prior RAAS blockers prescription tend to suffer severe disease (need for ICU admission, use of HFNC) than other group.