RAAS ANTAGONISTS IN THE TREATMENT OF ARTERIAL HYPERTENSION IN PATIENTS WITH COVID-19-ASSOCIATED PNEUMONIA

Abstract

Coronavirus disease COVID-19 has become a pandemic of the 21st century. According to the WHO data, more than 6.2 million people have died worldwide. Arterial hypertension (AH) is a risk factor for a severe course of COVID-19. AH doubles the risk of a lethal outcome twice. Therefore, the determination of the antihypertensive drug effect on the clinical course of coronavirus disease COVID-19 complicated by pneumonia is actual.
 Aim. The research is aimed to determine the effect of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin-II receptor blockers (ARBs) on the course of coronavirus disease COVID-19 complicated by pneumonia in unvaccinated patients with AH.
 Materials and methods. 77 unvaccinated patients hospitalized for coronavirus disease COVID-19 complicated by pneumonia were enrolled in the research. The patients included in the research were divided into 3 groups: the first group included 41 patients treated with ACE inhibitors, the second group included 22 patients who received ARBs, and the control group included 14 patients who took neither ACEi nor ARBs. None of the patients received statins.
 Results. The mean age in the three groups did not differ statistically (69.0 ± 2.6 years in the first group, 68.0 ± 2.9 years in the second group and 69.0 ± 6.4 years in the control group, p = 0.91). There was not statistical difference in body mass index in patients of all three groups (28.0 ± 1.6 kg/m2 in the first group, 29.3 ± 2.4 kg/m2 in the second and 28.1 ± 2.8 kg/m2 in the control group, p = 0.67). 5 (12.2%) patients in the first group, 4 (18.2%) patients in the second group and 2 (14.3%) patients in the third group died (p = 0.81). Oxygen therapy was used in 16 (39.0%) patients of the first group and in 14 (63.6%) patients of the second group (p = 0.07). During the hospital stay, a decline in the oxygen saturation <92% was observed in 17 (41.5%) patients of the first group, 12 (54.5%) in patients of the second group and 5 (35.7%) patients of the third group (p = 0.48). There was no significant difference in the number of patients treated with continuous positive airway pressure in all three groups (p=0.83), as well as invasive mechanical ventilation (p = 0.91). In the first and second groups, shortness of breath at the time of discharge was observed less frequently compared with the control group (p = 0.03). The number of points on the CAP-Sym questionnaire at the time of hospitalization was 25.8 ± 3.3 points in the first group, 29.5 ± 5.6 points in the second group and 26.5 ± 7.2 points in the control group (p = 0.51). At the time of discharge, the number of points on the CAP-Sym questionnaire in patients of the first group was 14.0 ± 2.5 points, in patients of the second group - 18.2 ± 3.7 points, in patients of the control group - 17.3 ± 4.4 points (p = 0.14).
 Conclusions. There was no effect of ACEi and ARBs on the severity and mortality of pneumonia associated with coronavirus disease COVID-19, compared with other antihypertensive drugs. Patients receiving ACE inhibitors tended to require supplemental oxygen less frequently than patients receiving ARBs. Patients taking ACE inhibitors or ARBs were less likely to complain of shortness of breath at the time of discharge than patients with hypertension whose antihypertensive therapy included neither ACE inhibitors nor ARBs.