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Beneficial Effects of Angiotensin II Receptor Blockers on Mortality in Patients with COVID-19: A Retrospective Study from 2019 to 2020 in China

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Abstract

Background

The COVID-19 pandemic has become a serious global public health problem. Although the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor type 1 blockers (ARBs) has been recommended in patients with COVID-19 and cardiovascular diseases (CVDs), according to the results of some small-sample retrospective analyses, there remains a lack of sufficient evidence to validate their efficacy. This multicenter retrospective study investigated whether ACEI/ARB administration was beneficial in patients with COVID-19 and CVDs.

Methods

A total of 11,231 patients with confirmed COVID-19 and CVDs, from 138 hospitals in Hubei Province, were included in this multicenter retrospective study. We compared the clinical characteristics and outcomes between the ARB and non-ARB groups and analyzed the risk factors for in-hospital death using univariate and multivariate Cox regression analyses and Kaplan–Meier curves.

Results

In the multivariate Cox regression model, after adjusting for age, gender, comorbidities, and in-hospital medications, ARB use was associated with lower all-cause mortality (adjusted HR, 0.53; 95% CI, 0.38–0.73; P < 0.001). After propensity score-matched analysis, the adjusted HR for the use of ARB associated with all-cause mortality was 0.62 (95% CI, 0.40–0.88; P = 0.02). Further subgroup analyses found that the adjusted HRs for the use of ARB associated with all-cause mortality were 0.52 (95% CI, 0.30–0.89; P = 0.016), 0.37 (95% CI, 0.21–0.64; P < 0.001), 0.42 (95% CI, 0.28–0.64; P < 0.001), and 0.55 (95% CI, 0.37–0.84; P = 0.005) in patients with heart failure, diabetes, and hypercholesterolemia, and severe COVID-19, respectively.

Conclusions

ARB administration was significantly associated with a lower risk of all-cause mortality in patients with COVID-19 and CVDs.

Trial registration

ClinicalTrials.gov NCT05615792.

https://www.clinicaltrials.gov/ct2/show/NCT05615792

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Data Availability

The data underlying this article will be shared on reasonable request to the corresponding author.

Code Availability

The code underlying this article will be shared on reasonable request to the corresponding author.

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Acknowledgements

The authors would like to thank all the patients, their families, and all investigators involved in this study.

Funding

This study was supported in part by the National Natural Science Foundation of China (Nos. 82241034 and C-0052) and Top-Notch Talent Program of Hubei Province and Tongji Hospital (No. 2021YBJRC005).

Author information

Author notes

  1. Ke Xu and Wu He contributed equally to this work.

Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave., Wuhan, 430030, China

    Ke Xu, Wu He, Bo Yu & Dao Wen Wang

  2. Health Commission of Hubei Provincial, Wuhan, 430079, China

    Kaineng Zhong & Da Zhou

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  1. Ke Xu
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Contributions

KX and WH designed the study, collected and analyzed data, performed the statistical analysis, and wrote the manuscript. BY, KZ, and DZ completed the data collation and was responsible for quality control. DWW designed the project, edited the manuscript, and supervised the study. All authors gave final approval and agree to be accountable for all aspects of work ensuring integrity and accuracy.

Corresponding author

Correspondence to Dao Wen Wang.

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Ethics Approval

This study was conducted in accordance with the principles of the Declaration of Helsinki and approved by the Research Ethics Committee of Tongji Medical College (no. TJ-IRB20210138).

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The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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Xu, K., He, W., Yu, B. et al. Beneficial Effects of Angiotensin II Receptor Blockers on Mortality in Patients with COVID-19: A Retrospective Study from 2019 to 2020 in China. Cardiovasc Drugs Ther (2023). https://doi.org/10.1007/s10557-023-07494-5

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