Table 2.
Characteristics of the Primary Inpatient Cohort
| Variable | Overall | Cohort | P Value | ||||||
|---|---|---|---|---|---|---|---|---|---|
| ACE Inhibitor | ARB | Other | ACE Inhibitor vs Other | ARB vs Other | ACE Inhibitor vs ARB | ||||
| Number of patients | 7933 | 2361 | 2226 | 3346 | <0.0001 | <0.0001 | <0.0001 | ||
| Age, median (IQR) | 77.0 (69.0–85.0) | 76.0 (68.0–83.0) | 76.0 (69.0–84.0) | 78.0 (70.0–86.0) | <0.0001 | <0.0001 | 0.12 | ||
| Age range | |||||||||
| 18–30 y | 11 (0.1%) | * | * | * | 0.39 | 0.93 | 0.79 | ||
| 31–40 y | 30 (0.4%) | * | * | * | 0.86 | 0.40 | 0.69 | ||
| 41–50 y | 173 (2.2%) | 60 (2.5%) | 47 (2.1%) | 66 (2.0%) | 0.18 | 0.79 | 0.39 | ||
| 51–60 y | 544 (6.9%) | 172 (7.3%) | 177 (8.0%) | 195 (5.8%) | 0.031 | 0.0022 | 0.43 | ||
| 61–70 y | 1523 (19.2%) | 499 (21.1%) | 415 (18.6%) | 609 (18.2%) | 0.0064 | 0.70 | 0.038 | ||
| 71–80 y | 2627 (33.1%) | 822 (34.8%) | 786 (35.3%) | 1019 (30.5%) | 0.00058 | 0.00017 | 0.75 | ||
| >80 y | 3025 (38.1%) | 794 (33.6%) | 792 (35.6%) | 1439 (43.0%) | <0.0001 | <0.0001 | 0.17 | ||
| Female sex | 4332 (54.6%) | 1171 (49.6%) | 1246 (56.0%) | 1915 (57.2%) | <0.0001 | 0.37 | <0.0001 | ||
| Medicare Advantage | 7296 (92.0%) | 2152 (91.1%) | 1991 (89.4%) | 3153 (94.2%) | <0.0001 | <0.0001 | 0.057 | ||
| Location | |||||||||
| Urban | 3574 (45.1%) | 1047 (44.3%) | 1048 (47.1%) | 1479 (44.2%) | 0.94 | 0.037 | 0.067 | ||
| Rural | 1623 (20.5%) | 488 (20.7%) | 463 (20.8%) | 672 (20.1%) | 0.61 | 0.54 | 0.94 | ||
| Suburban | 2714 (34.2%) | 822 (34.8%) | 708 (31.8%) | 1184 (35.4%) | 0.68 | 0.0062 | 0.033 | ||
| Unknown | 22 (0.3%) | * | * | * | 0.37 | 0.88 | 0.48 | ||
| Race† | |||||||||
| White | 4486 (56.5%) | 1352 (57.3%) | 1117 (50.2%) | 2017 (60.3%) | 0.0024 | <0.0001 | <0.0001 | ||
| Black | 2181 (27.5%) | 633 (26.8%) | 636 (28.6%) | 912 (27.3%) | 0.73 | 0.30 | 0.19 | ||
| Hispanic | 209 (2.6%) | 70 (3.0%) | 67 (3.0%) | 72 (2.2%) | 0.063 | 0.054 | 1.00 | ||
| Asian | 137 (1.7%) | 21 (0.9%) | 73 (3.3%) | 43 (1.3%) | 0.20 | <0.0001 | <0.0001 | ||
| Native American | * | * | * | * | 0.012 | 0.31 | 0.33 | ||
| Other | 156 (2.0%) | 38 (1.6%) | 64 (2.9%) | 54 (1.6%) | 0.93 | <0.001 | 0.0050 | ||
| Unknown | 756 (9.5%) | 241 (10.2%) | 267 (12.0%) | 248 (7.4%) | 0.00024 | <0.0001 | 0.060 | ||
| Geographic region | |||||||||
| Region of inpatient facility | |||||||||
| Northeast | 3335 (42.0%) | 950 (40.2%) | 947 (42.5%) | 1438 (43.0%) | 0.041 | 0.77 | 0.12 | ||
| South | 2750 (34.7%) | 807 (34.2%) | 829 (37.2%) | 1114 (33.3%) | 0.50 | 0.0027 | 0.033 | ||
| Midwest | 1528 (19.3%) | 482 (20.4%) | 378 (17.0%) | 668 (20.0%) | 0.70 | 0.0058 | 0.0033 | ||
| West | 320 (4.0%) | 122 (5.2%) | 72 (3.2%) | 126 (3.8%) | 0.013 | 0.33 | 0.0015 | ||
| State of inpatient facility | |||||||||
| New York | 1226 (15.5%) | 320 (13.6%) | 386 (17.3%) | 520 (15.5%) | 0.040 | 0.081 | 0.00045 | ||
| New Jersey | 796 (10.0%) | 212 (9.0%) | 260 (11.7%) | 324 (9.7%) | 0.39 | 0.019 | 0.0031 | ||
| Connecticut | 779 (9.8%) | 238 (10.1%) | 206 (9.3%) | 335 (10.0%) | 0.97 | 0.37 | 0.37 | ||
| Georgia | 666 (8.4%) | 188 (8.0%) | 208 (9.3%) | 270 (8.1%) | 0.92 | 0.11 | 0.11 | ||
| Florida | 542 (6.8%) | 141 (6.0%) | 184 (8.3%) | 217 (6.5%) | 0.46 | 0.014 | 0.0030 | ||
| Other | 3924 (49.5%) | 1262 (53.5%) | 982 (44.1%) | 1680 (50.2%) | 0.017 | <0.0001 | <0.0001 | ||
| Comorbid conditions | |||||||||
| Diabetes mellitus without complications | 4022 (50.7%) | 1339 (56.7%) | 1237 (55.6%) | 1446 (43.2%) | <0.0001 | <0.0001 | 0.45 | ||
| Myocardial infarction | 425 (5.4%) | 109 (4.6%) | 123 (5.5%) | 193 (5.8%) | 0.064 | 0.75 | 0.18 | ||
| Chronic heart failure | 2469 (31.1%) | 626 (26.5%) | 656 (29.5%) | 1187 (35.5%) | <0.0001 | <0.0001 | 0.028 | ||
| Chronic pulmonary disease | 2266 (28.6%) | 576 (24.4%) | 588 (26.4%) | 1102 (32.9%) | <0.0001 | <0.0001 | 0.12 | ||
| Peptic ulcer disease | 133 (1.7%) | 36 (1.5%) | 39 (1.8%) | 58 (1.7%) | 0.61 | 0.96 | 0.62 | ||
| AIDS | 33 (0.4%) | * | * | * | 0.60 | 0.50 | 0.21 | ||
| Rheumatologic disease | 435 (5.5%) | 91 (3.9%) | 146 (6.6%) | 198 (5.9%) | 0.00058 | 0.36 | <0.0001 | ||
| Diabetes mellitus, chronic complications | 3081 (38.8%) | 984 (41.7%) | 963 (43.3%) | 1134 (33.9%) | <0.0001 | <0.0001 | 0.29 | ||
| Metastatic cancer | 146 (1.8%) | 37 (1.6%) | 36 (1.6%) | 73 (2.2%) | 0.12 | 0.16 | 0.99 | ||
| Hemiplegia or paraplegia | 596 (7.5%) | 189 (8.0%) | 110 (4.9%) | 297 (8.9%) | 0.27 | <0.0001 | <0.0001 | ||
| Liver disease, mild | 477 (6.0%) | 120 (5.1%) | 129 (5.8%) | 228 (6.8%) | 0.0084 | 0.14 | 0.32 | ||
| Solid tumor without metastases | 923 (11.6%) | 265 (11.2%) | 252 (11.3%) | 406 (12.1%) | 0.31 | 0.38 | 0.95 | ||
| Liver disease, moderate to severe | 66 (0.8%) | 17 (0.7%) | 12 (0.5%) | 37 (1.1%) | 0.18 | 0.038 | 0.56 | ||
| Dementia | 1645 (20.7%) | 481 (20.4%) | 344 (15.5%) | 820 (24.5%) | 0.00028 | <0.0001 | <0.0001 | ||
| Peripheral vascular disease | 2687 (33.9%) | 755 (32.0%) | 624 (28.0%) | 1308 (39.1%) | <0.0001 | <0.0001 | 0.0040 | ||
| Renal failure, moderate to severe | 2351 (29.6%) | 592 (25.1%) | 641 (28.8%) | 1118 (33.4%) | <0.0001 | <0.0001 | 0.0050 | ||
| Cerebrovascular disease | 1744 (22.0%) | 507 (21.5%) | 445 (20.0%) | 792 (23.7%) | 0.055 | 0.0014 | 0.23 | ||
| Charlson Score, median (IQR) | 3.0 (2.0–5.0) | 3.0 (1.0–5.0) | 3.0 (1.0–5.0) | 3.0 (2.0–6.0) | <0.0001 | <0.0001 | 0.77 | ||
| Drug therapy | |||||||||
| Antihypertensives | |||||||||
| β‐blockers | 4277 (53.9%) | 1112 (47.1%) | 1095 (49.2%) | 2070 (61.9%) | <0.0001 | <0.0001 | 0.17 | ||
| Nondihydropyridine calcium channel blockers | 3438 (43.3%) | 929 (39.3%) | 959 (43.1%) | 1550 (46.3%) | <0.0001 | 0.019 | 0.011 | ||
| Dihydropyridine calcium channel blockers | 2972 (37.5%) | 826 (35.0%) | 848 (38.1%) | 1298 (38.8%) | 0.0037 | 0.62 | 0.031 | ||
| Thiazide or thiazide‐like diuretics | 1650 (20.8%) | 512 (21.7%) | 702 (31.5%) | 436 (13.0%) | <0.0001 | <0.0001 | <0.0001 | ||
| Loop diuretics | 2400 (30.3%) | 570 (24.1%) | 612 (27.5%) | 1218 (36.4%) | <0.0001 | <0.0001 | 0.010 | ||
| Centrally acting α agonists | 303 (3.8%) | 85 (3.6%) | 98 (4.4%) | 120 (3.6%) | 0.96 | 0.14 | 0.19 | ||
| Potassium‐sparing diuretics | 112 (1.4%) | 21 (0.9%) | 22 (1.0%) | 69 (2.1%) | 0.00069 | 0.0028 | 0.85 | ||
| Mineralocorticoid aldosterone antagonists | 435 (5.5%) | 93 (3.9%) | 135 (6.1%) | 207 (6.2%) | 0.00023 | 0.90 | 0.0012 | ||
| Renin inhibitors | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | <0.0001 | <0.0001 | <0.0001 | ||
| α‐adrenergic blocking agents | 247 (3.1%) | 70 (3.0%) | 76 (3.4%) | 101 (3.0%) | 0.97 | 0.46 | 0.43 | ||
| Direct vasodilators | 515 (6.5%) | 110 (4.7%) | 159 (7.1%) | 246 (7.4%) | <0.0001 | 0.81 | 0.00044 | ||
| Place in therapy | |||||||||
| First‐line | 6399 (80.7%) | 2361 (100.0%) | 2226 (100.0%) | 1812 (54.2%) | <0.0001 | <0.0001 | <0.0001 | ||
| Second‐line | 5478 (69.1%) | 1405 (59.5%) | 1388 (62.4%) | 2685 (80.2%) | <0.0001 | <0.0001 | 0.052 | ||
| Number of antihypertensive classes | |||||||||
| 1 | 2322 (29.3%) | 442 (18.7%) | 312 (14.0%) | 1568 (46.9%) | <0.0001 | <0.0001 | <0.0001 | ||
| 2 | 2625 (33.1%) | 850 (36.0%) | 692 (31.1%) | 1083 (32.4%) | 0.0047 | 0.33 | 0.00048 | ||
| 3+ | 2986 (37.6%) | 1069 (45.3%) | 1222 (54.9%) | 695 (20.8%) | <0.0001 | <0.0001 | <0.0001 | ||
| Number, median (IQR) | 2.0 (1.0–3.0) | 2.0 (2.0–3.0) | 3.0 (2.0–3.0) | 2.0 (1.0–2.0) | <0.0001 | <0.0001 | <0.0001 | ||
| Other drug therapies | |||||||||
| Statins | 4772 (60.2%) | 1528 (64.7%) | 1408 (63.3%) | 1836 (54.9%) | <0.0001 | <0.0001 | 0.32 | ||
| Other lipid‐lowering agents | 423 (5.3%) | 119 (5.0%) | 145 (6.5%) | 159 (4.8%) | 0.66 | 0.0055 | 0.038 | ||
| Oral anticoagulants | 1375 (17.3%) | 384 (16.3%) | 333 (15.0%) | 658 (19.7%) | 0.0012 | <0.0001 | 0.24 | ||
| Insulin | 1373 (17.3%) | 461 (19.5%) | 421 (18.9%) | 491 (14.7%) | <0.0001 | <0.0001 | 0.62 | ||
| Oral antihyperglycemic agents | 2188 (27.6%) | 820 (34.7%) | 738 (33.2%) | 630 (18.8%) | <0.0001 | <0.0001 | 0.27 | ||
| Follow‐up | |||||||||
| Follow‐up days, median (IQR) | 6.0 (3.0–11.0) | 6.0 (3.0–11.0) | 6.0 (3.0–11.0) | 7.0 (3.0–11.0) | 0.80 | 0.96 | 0.78 | ||
| Days to death, median (IQR) | 6.0 (3.0–11.0) | 7.0 (3.0–11.0) | 7.0 (3.0–13.0) | 5.0 (2.0–10.0) | 0.0092 | <0.0001 | 0.15 | ||
| Total mortality | 1130 (14.2%) | 319 (13.5%) | 345 (15.5%) | 466 (13.9%) | 0.70 | 0.088 | 0.048 | ||
The cohort includes individuals who were hospitalized with COVID‐19. ACE indicates angiotensin‐converting enzyme; ARB, angiotensin receptor blocker; and IQR, interquartile range.
*
Cells with values <11 were suppressed in accordance with the Centers for Medicare and Medicare Services cell size suppression policy for values from 1 to 10.
†
Race is unknown in all commercially insured enrollees.