Renin-Angiotensin-System Inhibitors Are Associated With Lower In-hospital Mortality in COVID-19 Patients Aged 80 and Older

Abstract

BackgroundOlder adults are at higher risk of morbidity and mortality for coronavirus disease 2019 (COVID-19). Renin-angiotensin-system inhibitors (RASi) were found to have a neutral or protective effect against mortality in COVID-19 adult patients.AimsWe investigated whether this association was confirmed also in COVID-19 older patients.MethodsThis is a prospective observational study on 337 hospitalized older adults (aged 80 years and older). We classified the study population according to usage of RASi before and during hospitalization. A propensity score analysis was also performed to confirm the findings.ResultsThe mean age was 87.4 ± 6.1 years. Patients taking RASi at home were 147 (43.6%). During hospitalization, 38 patients (11.3% of the entire study population) discontinued RASi, while 57 patients (16.9% of the entire study population) started RASi. In-hospital mortality was 43.9%. Patients taking RASi during hospitalization (patients who maintained their home RASi therapy + patients who started RASi during hospitalization) had a significantly lower in-hospital mortality than untreated patients [HR 0.48 (95% CI: 0.34–0.67)], even after adjustment for required respiratory support, functional status, albumin, inflammation, and cardiac biomarkers. The analysis of the groups derived from the “propensity score matching” (58 patients in each group) confirmed these results [HR 0.46 (95% CI: 0.23–0.91)].DiscussionDespite the high risk of death in older COVID-19 patients, RASi therapy during hospitalization was associated with a clinically relevant lower in-hospital mortality, likely due to the benefit of RAS modulation on the cardiopulmonary system during the acute phase of the disease.ConclusionOur findings confirm the protective role of RASi even in COVID-19 patients aged 80 years and older.

Telmisartan and losartan: The marked differences between their chemical and pharmacological properties may explain the difference in therapeutic efficacy in hospitalized patients with COVID‐19

“…Many studies have shown that ACE inhibitor/ARB use was associated with reduced mortality among COVID‐19 patients. 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 Considering that telmisartan is a very safe ARB (even in high doses it presents placebo‐like adverse effects), cheap and available practically throughout the planet, it can represent an adequate off‐label therapeutic tool in patients with COVID‐19, especially in countries with low resources, to face current and future waves of SARS‐CoV‐2.…”

“…Many studies have shown that ACE inhibitor/ARB use was associated with reduced mortality among COVID-19 patients. [26][27][28][29][30][31][32][33] Considering that telmisartan is a very safe ARB (even in high doses The disbinding of telmisartan from the AT1 receptor is very slow (greater than losartan and EXP3174). practically demonstrating an irreversible antagonism.…”

COVID-19 and cardiovascular disease in patients with chronic kidney disease

“…Some authors warned against the potential deleterious effect of RAASi, which has been shown to increase ACE2 expression [ 23 ], whereas others argued that the treatment may be beneficial, as it would increase the anti-inflammatory and anti-fibrotic actions of angiotensin 1–7 [ 24 ]. Observational studies showed controversial results, ranging from no effect on COVID-19 infection susceptibility [ 25 ], or severity of the disease and mortality [ 26 ], to improvements in survival in individuals treated with RAASi [ 27 , 28 ], with beneficial effects observed only in hypertensive patients [ 29 ] or only in males [ 30 ].…”