The Use of Angiotensin-Converting Enzyme Inhibitors in Hospitalized Patients With COVID-19 Is Associated With a Lower Risk of Mortality

INTRODUCTION: The relationship between the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), diabetes mellitus (DM), and the risk of death in patients with COVID-19 remains controversial. We hypothesized that DM and certain characteristics of the COVID-19 course during hospital treatment may alter the assessment of the effect of ACEIs/ARBs on COVID-19 outcomes. METHODS: The records of 153 COVID-19 inpatients admitted to a municipal clinic in Kyiv, Ukraine, between October and December 2021 were reviewed. To assess the effect of ARBs/ACEIs and other hypotensive drugs, a No Hypotensives group was used for comparison. A multivariable logistic regression model was employed to assess the odds ratio (OR) of death. RESULTS: If DM was known at the time of hospitalization (n=28), there was a higher proportion of deaths compared to the group without DM (n=125): 53.6% vs. 12.8%, p < 0.001. After adjusting for age, minimal O2 saturation, DM, and antihypertensive therapy, the ACEIs-associated OR was 0.10 (0.02-0.69). The DM-associated OR was 8.25 (1.92-35.42). CONCLUSION: The use of ACEIs in the treatment of COVID-19 inpatients is associated with a lower risk of mortality compared to those not using hypotensive treatment, regardless of the presence of DM.