DO RENIN-ANGIOTENSIN SYSTEM INHIBITORS HAVE ANY EFFECT ON THE SEVERITY OF COVID-19 IN HYPERTENSIVE SUBJECTS?

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Objective: An increase in angiotensin-converting enzyme (ACE) type 2 levels would stimulate the infection by SARS-Cov-2. On the other hand, the inhibition of the effect of angiotensin II could decrease the inflammatory and oxidative response related to the severity of the disease. Our purpose is to assess the effect of renin-angiotensin inhibitors (RASi) on the severity of COVID-19 in a primary care population of hypertensives. Design and method: Multicenter, observational, cross-sectional, retrospective and analytical study. The subjects were enrolled by a random sampling from 10 autonomous regions in Spain, among patients over 18 years-old with treated hypertension and COVID-19 (PCR positive), within the framework of primary health care (119 physicians). Patients were treated 6 months prior data collection (May 2021–February 2022) in the third wave. Multivariate logistic regression analysis adjusted by age, sex, smoking, and obesity was performed to assess the relationship of COVID-19 severity with anti-hypertensive therapy. Results: 1372 patients were enrolled, mean age 67.1±13.6 years, women 50.8%, smoking 12.5%, obesity 43.9%, diabetes 27.5%, controlled arterial hypertension 55.9% (office BP <140 /90). The severity of COVID-19 was: mild-asymptomatic 971 (70.8%), hospital admission 401 (29.2%), ICU admission 74 (5.4%) and death 48 (Fatality rate, 4%). 64.3% of patients were treated with RASi alone or as add-on therapy during COVID-19. Comparing the progression of COVID-19 between those patients who required hospitalisation versus mild-asymptomatic, we found statistically significant differences (Figure 1): RASi vs Diuretics(D)+Calcium channel blockers(CCB)+RASi (OR = 0.36; 95%CI: 0.22-0.57; p<0.001) and D+RASi vs D (OR = 0.49; 95%CI: 0.28-0.93; p<0.05). RASi alone or in combination vs other anti-hypertensives only showed a non-significant trend for fewer hospitalizations (OR = 0.87; 95%CI: 0.68-1.12; p = 0.274). There were no differences between survivors vs non-survivors treated with RASi: 63.2% vs 58.3% (p = 0.496). Conclusions: RASi do not worsen the severity of COVID-19 among hypertensive patients. Regarding its possible protective effect on the progression of the disease, the results are not conclusive, although there could be a trend in this sense, especially when RASi are compared with some antihypertensive combinations.