Table 2.
Summary of studies investigating COVID‐19 in patients with hypertension, including those receiving renin‐angiotensin system inhibitors
| AuthorReference | Location | Design | Patients | Evidence |
|---|---|---|---|---|
| Li, et al 48 | Hubei province, China | Retrospective case series | 1178 pts hospitalized with COVID‐19 |
362 pts (31%) had HTN; 115/362 (32%) were taking ACEI/ARBs. In‐hospital mortality in pts with vs without HTN: 21% vs 11%. Use of ACEI/ARBs did not differ between pts with severe vs non‐severe COVID‐19 illness (33% vs 33%; P = .65), or between non‐survivors and survivors (27% vs 33%; P = .34). |
| Mancia, et al 45 | Lombardy region, Italy | Population‐based case‐control study | 6272 cases with confirmed COVID‐19 and 30,759 matched controls |
Use of ACEI/ARBs was more common in cases vs controls because cases had a higher rate of CVD. After adjustment for coexisting conditions, there was no association between use of ACEI or ARB and the risk of COVID‐19 infection (OR 0.96, 95% CI 0.87‐1.07 and OR 0.95, 95% CI 0.87‐1.07). |
| Mehta, et al 46 | Ohio & Florida, USA | Retrospective cohort study | 18,472 pts tested for COVID‐19 |
2285 pts were taking ACEIs or ARBs. There was no significant association between ACEI/ARB use and COVID‐19 test positivity (overlap propensity score‐weighted OR 0.97, 95% CI 0.81‐1.15). |
| Reynolds, et al 47 | New York, USA | Retrospective observational study | 12,594 pts tested for COVID‐19 |
4357 pts (35%) had a history of HTN; 2573/4357 (59.1%) had a positive test result; and 634 of these (25%) had severe illness. In propensity score‐matched groups, the likelihood of a positive test in pts with HTN was not affected by treatment with an ACEI or ARB. |
| Yang, et al 49 | Wuhan, China | Retrospective observational study | 126 pts with HTN and COVID‐19 and 125 age‐ and sex‐matched controls with COVID‐19 but no HTN |
Levels of hs‐CRP (P = .049) and procalcitonin (P = .008) were significantly lower in pts with HTN who were vs were not receiving ACEI/ARBs. The proportion of critical pts (9% vs 23%; P = .061) and the death rate (5% vs 13%; P = .216) were numerically but not significantly lower in the ACEI/ARB vs non‐ACEI/ARB group. |
| Zhang, et al 50 | Hubei province, China | Multicenter (9), retrospective observational study | 1128 pts with HTN and COVID‐19 |
188 pts were taking ACEI/ARB. In a Cox model adjusted for age, sex, comorbidities, and in‐hospital medication, all‐cause mortality was lower in the pts who were vs were not receiving ACEI/ARB (HR 0.37, 95% CI 0.150.89; P = .03). |
Abbreviations: ACEI, angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; CI, confidence interval; CVD, cardiovascular disease; HR, hazard ratio; hs‐CRP, hig sensitivity C‐reactive protein; HTN, hypertension; OR, odds ratio; pts, patients.