• Iván J Núñez-Gil, Iván Olier, Gisela Feltes, María C Viana-Llamas, Charbel Maroun-Eid, Rodolfo Romero, Inmaculada Fernández-Rozas, Aitor Uribarri, Victor M Becerra-Muñoz, Emilio Alfonso-Rodriguez, Marcos García-Aguado, Javier Elola, Alex Castro-Mejía, Martino Pepe, Juan Fortunato Garcia-Prieto, Adelina Gonzalez, Fabrizio Ugo, Enrico Cerrato, Elvira Bondia, Sergio Raposeiras-Roubin, Jorge L Jativa Mendez, Carolina Espejo, Álvaro López-Masjuan, Francisco Marin, Javier López-Pais, Mohammad Abumayyaleh, Miguel Corbi-Pascual, Christoph Liebetrau, Harish Ramakrishna, Vicente Estrada, Carlos Macaya, Antonio Fernandez-Ortiz, and HOPE COVID-19 Investigators (Cols Appendix).
• Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain. Electronic address: ibnsky@yahoo.es.
• Am. Heart J. 2021 Jul 1; 237: 104-115.

BackgroundThe use of Renin-Angiotensin system inhibitors (RASi) in patients with coronavirus disease 2019 (COVID-19) has been questioned because both share a target receptor site.MethodsHOPE-COVID-19 (NCT04334291) is an international investigator-initiated registry. Patients are eligible when discharged after an in-hospital stay with COVID-19, dead or alive. Here, we analyze the impact of previous and continued in-hospital treatment with RASi in all-cause mortality and the development of in-stay complications.ResultsWe included 6503 patients, over 18 years, from Spain and Italy with data on their RASi status. Of those, 36.8% were receiving any RASi before admission. RASi patients were older, more frequently male, with more comorbidities and frailer. Their probability of death and ICU admission was higher. However, after adjustment, these differences disappeared. Regarding RASi in-hospital use, those who continued the treatment were younger, with balanced comorbidities but with less severe COVID19. Raw mortality and secondary events were less frequent in RASi. After adjustment, patients receiving RASi still presented significantly better outcomes, with less mortality, ICU admissions, respiratory insufficiency, need for mechanical ventilation or prone, sepsis, SIRS and renal failure (p<0.05 for all). However, we did not find differences regarding the hospital use of RASi and the development of heart failure.ConclusionRASi historic use, at admission, is not related to an adjusted worse prognosis in hospitalized COVID-19 patients, although it points out a high-risk population. In this setting, the in-hospital prescription of RASi is associated with improved survival and fewer short-term complications.Copyright © 2021 Elsevier Inc. All rights reserved.

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