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Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Withdrawal Is Associated with Higher Mortality in Hospitalized Patients with COVID-19

Department of Internal Medicine, La Princesa University Hospital, Healthcare Research Institute-La Princesa Biomedical Research Foundation, 28006 Madrid, Spain
Department of Internal Medicine, La Paz University Hospital, Hospital La Paz Institute for Health Research (IdiPAZ), Autonomous University of Madrid, 28046 Madrid, Spain
Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, 14004 Córdoba, Spain
CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, 28029 Madrid, Spain
Internal Medicine Department, 12 de Octubre University Hospital, 28041 Madrid, Spain
Internal Medicine Department, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
Internal Medicine Department, Zamora Hospital Complex, 49022 Zamora, Spain
Internal Medicine Department, San Juan de Alicante University Hospital, 03550 San Juan de Alicante, Spain
Internal Medicine Department, Henares Hospital, 28822 Coslada, Spain
Internal Medicine Department, La Fe University Hospital, 46026 Valencia, Spain
Internal Medicine Department, Costa del Sol Hospital, 29603 Marbella, Spain
Internal Medicine Department, Ourense University Hospital Complex, 32005 Ourense, Spain
Internal Medicine Department, Infanta Margarita Hospital, 14940 Cabra, Spain
Internal Medicine Department, Alto Guadalquivir Hospital, 23740 Andújar, Spain
Internal Medicine Department, Pozoblanco Hospital, 14400 Pozoblanco, Spain
Internal Medicine Department, Platón Hospital, 08006 Barcelona, Spain
Internal Medicine Department, Castellón University General Hospital, 12004 Castellón de la Plana, Spain
Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), 29010 Málaga, Spain
Internal Medicine Department, Infanta Cristina University Hospital, 28981 Parla, Spain
Internal Medicine Department, Gregorio Marañón University Hospital, 28007 Madrid, Spain
Authors to whom correspondence should be addressed.
These authors contributed equally to this work.
A complete list of the SEMI-COVID-19 Network members is provided in the Supplementary Materials.
Academic Editors: Marco Luigetti and Giovanni Frisullo
J. Clin. Med. 2021, 10(12), 2642;
Received: 22 May 2021 / Revised: 8 June 2021 / Accepted: 11 June 2021 / Published: 15 June 2021
Our main aim was to describe the effect on the severity of ACEI (angiotensin-converting enzyme inhibitor) and ARB (angiotensin II receptor blocker) during COVID-19 hospitalization. A retrospective, observational, multicenter study evaluating hospitalized patients with COVID-19 treated with ACEI/ARB. The primary endpoint was the incidence of the composite outcome of prognosis (IMV (invasive mechanical ventilation), NIMV (non-invasive mechanical ventilation), ICU admission (intensive care unit), and/or all-cause mortality). We evaluated both outcomes in patients whose treatment with ACEI/ARB was continued or withdrawn. Between February and June 2020, 11,205 patients were included, mean age 67 years (SD = 16.3) and 43.1% female; 2162 patients received ACEI/ARB treatment. ACEI/ARB treatment showed lower all-cause mortality (p < 0.0001). Hypertensive patients in the ACEI/ARB group had better results in IMV, ICU admission, and the composite outcome of prognosis (p < 0.0001 for all). No differences were found in the incidence of major adverse cardiovascular events. Patients previously treated with ACEI/ARB continuing treatment during hospitalization had a lower incidence of the composite outcome of prognosis than those whose treatment was withdrawn (RR 0.67, 95%CI 0.63–0.76). ARB was associated with better survival than ACEI (HR 0.77, 95%CI 0.62–0.96). ACEI/ARB treatment during COVID-19 hospitalization was associated with protection on mortality. The benefits were greater in hypertensive, those who continued treatment, and those taking ARB. View Full-Text
Keywords: COVID-19; ACEI; ARB; prognosis; MACE COVID-19; ACEI; ARB; prognosis; MACE
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MDPI and ACS Style

Roy-Vallejo, E.; Sánchez Purificación, A.; Torres Peña, J.D.; Sánchez Moreno, B.; Arnalich, F.; García Blanco, M.J.; López Miranda, J.; Romero-Cabrera, J.L.; Herrero Gil, C.R.; Bascunana, J.; Rubio-Rivas, M.; Pintos Otero, S.; Martínez Sempere, V.; Ballano Rodríguez-Solís, J.; Gil Sánchez, R.; Luque del Pino, J.; González Noya, A.; Navas-Alcántara, M.S.; Cortés Rodríguez, B.; Alcalá, J.N.; Suárez-Lombraña, A.; Andrés Soler, J.; Gómez-Huelgas, R.; Casas-Rojo, J.M.; Millán Núñez-Cortés, J.; on behalf of the SEMI-COVID-19 Network. Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Withdrawal Is Associated with Higher Mortality in Hospitalized Patients with COVID-19. J. Clin. Med. 2021, 10, 2642.

AMA Style

Roy-Vallejo E, Sánchez Purificación A, Torres Peña JD, Sánchez Moreno B, Arnalich F, García Blanco MJ, López Miranda J, Romero-Cabrera JL, Herrero Gil CR, Bascunana J, Rubio-Rivas M, Pintos Otero S, Martínez Sempere V, Ballano Rodríguez-Solís J, Gil Sánchez R, Luque del Pino J, González Noya A, Navas-Alcántara MS, Cortés Rodríguez B, Alcalá JN, Suárez-Lombraña A, Andrés Soler J, Gómez-Huelgas R, Casas-Rojo JM, Millán Núñez-Cortés J, on behalf of the SEMI-COVID-19 Network. Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Withdrawal Is Associated with Higher Mortality in Hospitalized Patients with COVID-19. Journal of Clinical Medicine. 2021; 10(12):2642.

Chicago/Turabian Style

Roy-Vallejo, Emilia, Aquilino Sánchez Purificación, José David Torres Peña, Beatriz Sánchez Moreno, Francisco Arnalich, María José García Blanco, José López Miranda, Juan Luis Romero-Cabrera, Carmen Rosario Herrero Gil, José Bascunana, Manuel Rubio-Rivas, Sara Pintos Otero, Verónica Martínez Sempere, Jesús Ballano Rodríguez-Solís, Ricardo Gil Sánchez, Jairo Luque del Pino, Amara González Noya, María Sierra Navas-Alcántara, Begoña Cortés Rodríguez, José Nicolás Alcalá, Ana Suárez-Lombraña, Jorge Andrés Soler, Ricardo Gómez-Huelgas, José Manuel Casas-Rojo, Jesús Millán Núñez-Cortés, and on behalf of the SEMI-COVID-19 Network. 2021. "Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Withdrawal Is Associated with Higher Mortality in Hospitalized Patients with COVID-19" Journal of Clinical Medicine 10, no. 12: 2642.

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