• Álvaro Aparisi, Pablo Catalá, Ignacio J Amat-Santos, Marta Marcos-Mangas, Diego López-Otero, Carlos Veras, Javier López-Pais, Gonzalo Cabezón-Villalba, Carla Eugenia Cacho Antonio, Jordi Candela, Pablo Antúnez-Muiños, José Francisco Gil, Teba González Ferrero, Gino Rojas, Marta Pérez-Poza, Aitor Uribarri, Oscar Otero-García, Pablo Elpidio García-Granja, Víctor Jiménez Ramos, Ana Revilla, Carlos Dueñas, Itzíar Gómez, José Ramón González-Juanatey, and J Alberto San Román.
• Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain. Electronic address: alvaro_aparisi@hotmail.com.
• Med Clin (Barc). 2022 Apr 8; 158 (7): 315323315-323.

BackgroundHypertension is a prevalent condition among SARS-CoV-2 infected patients. Whether renin-angiotensin-aldosterone system (RAAS) inhibitors are beneficial or harmful is controversial.MethodsWe have performed a national retrospective, nonexperimental comparative study from two tertiary hospitals to evaluate the impact of chronic use of RAAS inhibitors in hypertensive COVID-19 patients. A meta-analysis was performed to strengthen our findings.ResultsOf 849 patients, 422 (49.7%) patients were hypertensive and 310 (73.5%) were taking RAAS inhibitors at baseline. Hypertensive patients were older, had more comorbidities, and a greater incidence of respiratory failure (-0.151 [95% CI -0.218, -0.084]). Overall mortality in hypertensive patients was 28.4%, but smaller among those with prescribed RAAS inhibitors before (-0.167 [95% CI -0.220, -0.114]) and during hospitalization (0.090 [-0.008,0.188]). Similar findings were observed after two propensity score matches that evaluated the benefit of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers among hypertensive patients. Multivariate logistic regression analysis of hypertensive patients found that age, diabetes mellitus, C-reactive protein, and renal failure were independently associated with all-cause mortality. On the contrary, ACEIs decreased the risk of death (OR 0.444 [95% CI 0.224-0.881]). Meta-analysis suggested a protective benefit of RAAS inhibitors (OR 0.6 [95% CI 0.42-0.8]) among hypertensive COVID-19.ConclusionOur data suggest that RAAS inhibitors may play a protective role in hypertensive COVID-19 patients. This finding was supported by a meta-analysis of the current evidence. Maintaining these medications during hospital stay may not negatively affect COVID-19 outcomes.Copyright © 2021 Elsevier España, S.L.U. All rights reserved.

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