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Impact of renin-angiotensin-aldosterone system inhibition on mortality in critically ill COVID-19 patients with pre-existing hypertension: a prospective cohort study.
BMC Cardiovasc Disord. 2022 03 23; 22(1):123.BC

Abstract

BACKGROUND

The influence of renin-angiotensin-aldosterone system (RAAS) inhibitors on the critically ill COVID-19 patients with pre-existing hypertension remains uncertain. This study examined the impact of previous use of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) on the critically ill COVID-19 patients.

METHODS

Data from an international, prospective, observational cohort study involving 354 hospitals spanning 54 countries were included. A cohort of 737 COVID-19 patients with pre-existing hypertension admitted to intensive care units (ICUs) in 2020 were targeted. Multi-state survival analysis was performed to evaluate in-hospital mortality and hospital length of stay up to 90 days following ICU admission.

RESULTS

A total of 737 patients were included-538 (73%) with pre-existing hypertension had received ACEi/ARBs before ICU admission, while 199 (27%) had not. Cox proportional hazards model showed that previous ACEi/ARB use was associated with a decreased hazard of in-hospital death (HR, 0.74, 95% CI 0.58-0.94). Sensitivity analysis adjusted for propensity scores showed similar results for hazards of death. The average length of hospital stay was longer in ACEi/ARB group with 21.2 days (95% CI 19.7-22.8 days) in ICU and 6.7 days (5.9-7.6 days) in general ward compared to non-ACEi/ARB group with 16.2 days (14.1-18.6 days) and 6.4 days (5.1-7.9 days), respectively. When analysed separately, results for ACEi or ARB patient groups were similar for both death and discharge.

CONCLUSIONS

In critically ill COVID-19 patients with comorbid hypertension, use of ACEi/ARBs prior to ICU admission was associated with a reduced risk of in-hospital mortality following adjustment for baseline characteristics although patients with ACEi/ARB showed longer length of hospital stay. Clinical trial registration The registration number: ACTRN12620000421932; The date of registration: 30, March 2020; The URL of the registration: https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12620000421932 .

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Authors+Show Affiliations

Sato K
Critical Care Research Group, The Prince Charles Hospital, Level 3, Clinical Sciences Building, Chermside, Brisbane, QLD, 4032, Australia. m02045ks@gmail.com. Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. m02045ks@gmail.com.
White N
Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, Queensland University of Technology (QUT), Brisbane, QLD, Australia.
Fanning JP
Critical Care Research Group, The Prince Charles Hospital, Level 3, Clinical Sciences Building, Chermside, Brisbane, QLD, 4032, Australia. Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Obonyo N
Critical Care Research Group, The Prince Charles Hospital, Level 3, Clinical Sciences Building, Chermside, Brisbane, QLD, 4032, Australia. Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. Wellcome Trust Centre for Global Health Research, Imperial College London, London, UK. Initiative to Develop African Research Leaders/KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
Yamashita MH
Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
Appadurai V
Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. Department of Cardiology, The Prince Charles Hospital, Brisbane, QLD, Australia.
Ciullo A
Division of Emergency Medicine, Department of Surgery, University of Utah Health, Salt Lake City, UT, 84132, USA.
May M
Department of Microbiology, Sullivan Nicolaides Pathology, Brisbane, QLD, Australia.
Worku ET
Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, QLD, Australia.
Helms L
Critical Care Research Group, The Prince Charles Hospital, Level 3, Clinical Sciences Building, Chermside, Brisbane, QLD, 4032, Australia.
Ohshimo S
Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Juzar DA
Intensive Cardiovascular Care Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia. Division Intensive & Emergency Cardiovascular Care, Department Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
Suen JY
Critical Care Research Group, The Prince Charles Hospital, Level 3, Clinical Sciences Building, Chermside, Brisbane, QLD, 4032, Australia. Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
Bassi GL
Critical Care Research Group, The Prince Charles Hospital, Level 3, Clinical Sciences Building, Chermside, Brisbane, QLD, 4032, Australia. Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain.
Fraser JF
Critical Care Research Group, The Prince Charles Hospital, Level 3, Clinical Sciences Building, Chermside, Brisbane, QLD, 4032, Australia. Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, QLD, Australia.
Arora RC
Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
COVID-19 Critical Care Consortium Investigators
No affiliation info available

MeSH

Angiotensin Receptor AntagonistsAngiotensin-Converting Enzyme InhibitorsCOVID-19Cohort StudiesCritical IllnessHospital MortalityHumansHypertensionProspective StudiesRenin-Angiotensin SystemRetrospective Studies

Pub Type(s)

Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

35321649

Citation

Sato, Kei, et al. "Impact of Renin-angiotensin-aldosterone System Inhibition On Mortality in Critically Ill COVID-19 Patients With Pre-existing Hypertension: a Prospective Cohort Study." BMC Cardiovascular Disorders, vol. 22, no. 1, 2022, p. 123.
Sato K, White N, Fanning JP, et al. Impact of renin-angiotensin-aldosterone system inhibition on mortality in critically ill COVID-19 patients with pre-existing hypertension: a prospective cohort study. BMC Cardiovasc Disord. 2022;22(1):123.
Sato, K., White, N., Fanning, J. P., Obonyo, N., Yamashita, M. H., Appadurai, V., Ciullo, A., May, M., Worku, E. T., Helms, L., Ohshimo, S., Juzar, D. A., Suen, J. Y., Bassi, G. L., Fraser, J. F., & Arora, R. C. (2022). Impact of renin-angiotensin-aldosterone system inhibition on mortality in critically ill COVID-19 patients with pre-existing hypertension: a prospective cohort study. BMC Cardiovascular Disorders, 22(1), 123. https://doi.org/10.1186/s12872-022-02565-1
Sato K, et al. Impact of Renin-angiotensin-aldosterone System Inhibition On Mortality in Critically Ill COVID-19 Patients With Pre-existing Hypertension: a Prospective Cohort Study. BMC Cardiovasc Disord. 2022 03 23;22(1):123. PubMed PMID: 35321649.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of renin-angiotensin-aldosterone system inhibition on mortality in critically ill COVID-19 patients with pre-existing hypertension: a prospective cohort study. AU - Sato,Kei, AU - White,Nicole, AU - Fanning,Jonathon P, AU - Obonyo,Nchafatso, AU - Yamashita,Michael H, AU - Appadurai,Vinesh, AU - Ciullo,Anna, AU - May,Meryta, AU - Worku,Elliott T, AU - Helms,Leticia, AU - Ohshimo,Shinichiro, AU - Juzar,Dafsah A, AU - Suen,Jacky Y, AU - Bassi,Gianluigi Li, AU - Fraser,John F, AU - Arora,Rakesh C, AU - ,, Y1 - 2022/03/23/ PY - 2021/09/11/received PY - 2022/03/16/accepted PY - 2022/3/24/entrez PY - 2022/3/25/pubmed PY - 2022/3/31/medline KW - Angiotensin receptor blockers KW - Angiotensin-converting enzyme inhibitors KW - COVID-19 KW - Critical care KW - Severe acute respiratory syndrome coronavirus 2 SP - 123 EP - 123 JF - BMC cardiovascular disorders JO - BMC Cardiovasc Disord VL - 22 IS - 1 N2 - BACKGROUND: The influence of renin-angiotensin-aldosterone system (RAAS) inhibitors on the critically ill COVID-19 patients with pre-existing hypertension remains uncertain. This study examined the impact of previous use of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) on the critically ill COVID-19 patients. METHODS: Data from an international, prospective, observational cohort study involving 354 hospitals spanning 54 countries were included. A cohort of 737 COVID-19 patients with pre-existing hypertension admitted to intensive care units (ICUs) in 2020 were targeted. Multi-state survival analysis was performed to evaluate in-hospital mortality and hospital length of stay up to 90 days following ICU admission. RESULTS: A total of 737 patients were included-538 (73%) with pre-existing hypertension had received ACEi/ARBs before ICU admission, while 199 (27%) had not. Cox proportional hazards model showed that previous ACEi/ARB use was associated with a decreased hazard of in-hospital death (HR, 0.74, 95% CI 0.58-0.94). Sensitivity analysis adjusted for propensity scores showed similar results for hazards of death. The average length of hospital stay was longer in ACEi/ARB group with 21.2 days (95% CI 19.7-22.8 days) in ICU and 6.7 days (5.9-7.6 days) in general ward compared to non-ACEi/ARB group with 16.2 days (14.1-18.6 days) and 6.4 days (5.1-7.9 days), respectively. When analysed separately, results for ACEi or ARB patient groups were similar for both death and discharge. CONCLUSIONS: In critically ill COVID-19 patients with comorbid hypertension, use of ACEi/ARBs prior to ICU admission was associated with a reduced risk of in-hospital mortality following adjustment for baseline characteristics although patients with ACEi/ARB showed longer length of hospital stay. Clinical trial registration The registration number: ACTRN12620000421932; The date of registration: 30, March 2020; The URL of the registration: https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12620000421932 . SN - 1471-2261 UR - https://www.unboundmedicine.com/medline/citation/35321649/Impact_of_renin_angiotensin_aldosterone_system_inhibition_on_mortality_in_critically_ill_COVID_19_patients_with_pre_existing_hypertension:_a_prospective_cohort_study_ DB - PRIME DP - Unbound Medicine ER -