ASSOCIATION OF IN-PATIENT OUTCOMES AND RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITOR USE AMONG HYPERTENSIVE PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19)

Abstract

Objective: RAAS inhibitors were speculated to increase expression of ACE2 receptors in the respiratory tract which was feared to lead to poorer outcomes among hypertensive patients infected with COVID-19. Current evidence has not confirmed Renin-Angiotensin-Aldosterone System inhibitors exposure as harmful in patients with COVID-19 infection. This study aims to determine the association between use of RAAS inhibitors and in-patient outcomes of adult hypertensive patients admitted for COVID-19. Design and method: A cross-sectional analytical study using case records was done on adult hypertensive patients admitted for COVID19 starting from March 2020 to March 2021 in a tertiary government hospital. The association of RAAS inhibitor use and in-patient outcomes was determined using Fisher’s chi-square test. Results: A total of 2,264 charts were reviewed for all COVID 19 patients admitted from March 2020 to March 2021, and 671 patients were determined to be hypertensive. Majority of hypertensive COVID-19 patients were male (52%), elderly (58%) and with moderate disease severity (51%). The most common comorbidities were community acquired pneumonia (59%), type 2 diabetes mellitus (44%) and chronic kidney disease (22%). A total of 66% (n = 442) of the hypertensive patients admitted for COVID were on RAAS inhibitors with losartan (40%) as the most commonly used agent. RAAS inhibitor use was not found to be associated with mortality (OR 0.74, 95% CI 0.57–1.10) and development of acute kidney injury (OR 1.12, 95% CI 1.12–1.69) among hypertensive COVID19 patients. However, RAAS inhibitor use was associated with decreased mortality among hypertensive patients classified with COVID-19 moderate disease (OR 0.42, 0.19–0.92, p-value 0.02). Conclusions: RAAS inhibitor use was not associated with increased mortality and development of acute kidney injury.