The effects of different antihypertensive medications, steroids and beta blocker on COVID-19 outcomes in a biracial CKD and non-CKD cohort

Abstract

Early on in the COVID-19 pandemic it was reported that angiotensin converting enzyme 2 inhibitors (ACE2i) could be associated with worse disease course due to potential increase in ACE2 receptors which SARS-CoV2 virus uses for cellular entry. Subsequent studies refuted such concerns, reporting that the continued use of ACEis and angiotensin receptor blockers (ARBs) in hypertensive individuals is in fact protective. Moreover, certain comorbidities, such as hypertension and heart disease, have been linked to an increased risk of disease severity. However, there is still paucity of data evaluating the effects of the use of different antihypertensive medications, steroids and beta blockers in chronic kidney disease (CKD) populations and in individuals with normal kidney function. This study was designed to evaluate the potential risk associated with renin angiotensin system inhibitors, calcium channel blocker, mineralocorticoid receptor blocker, steroids and beta blockers in a cohort of mostly African Americans and Caucasians. We conducted a retrospective study on patients who were admitted to the Detroit Medical Center, Detroit, MI during March and April of 2020. The data were collected through the medical chart reviews. We assessed 330 patients using inclusion criteria of age > 18 years and a positive SARS-CoV2 PCR test. We used the mean, standard deviation/standard error of mean, and percentages when appropriate for the description of patient characteristics. Group differences (CKD vs. non-CKD) were compared using the Pearson χ2 test. P-values of <0.05 were regarded as significant. We conducted binary logistic regression analysis to determine the effect of biological sex and CKD status on death due to COVID-19 during hospitalization. We conducted multivariate regression analysis for factors contributing to death during hospitalization due to COVID-19 and ICU admission, evaluating the contribution of different medications, comorbidities, and clinical course of the disease. On regression analyses, the odds of death in the hospital due to COVID-19 infection was not significantly associated with either biological sex or CKD status in our sample population. The odds of dying in the hospital were higher in patients who were on calcium channel blockers (OR 2.99, 95% CI 1.29-6.93, P = 0.01) and steroids (OR 4.23, 95% CI 1.17-15.31, P = 0.03). The only significance for ICU admission was obtained for steroid use (OR 1.872, 95% CI 1.059-3.311, P = 0.03). Likewise, COPD was the only comorbidity found to be associated with ICU admission (OR 2.38, 95% CI 1.282 - 4.426, P = 0.006), Significant associations were not observed for patients taking ACEis, ARBs, mineralocorticoid receptor inhibitors, diuretics, beta blockers and sympatholytics. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.