ACE inhibitor use prior to hospitalization boosts survival for COVID-19 patients

Hospitalized COVID-19 patients who were already taking angiotensin-converting enzyme (ACE) inhibitors have a reduced risk of mortality, according to new findings published in the Journal of the American Heart Association.

The authors explored data from more than 700 patients who were treated in one of four regions in Italy from Feb. 22 to April 1, 2020. All patients were 50 years old or older, a choice the team made based on the work of prior researchers.

Prior to hospitalization, 21.9% of the cohort had already been using ACE inhibitors and another 17% were already on angiotensinogen II receptor blockers (ARBs). The overall mortality rate was 15.1%, and it increased with age.

Overall, the authors found, antecedent ACE inhibitor use was associated with reduced mortality after adjustments were made for age, hypertension, diabetes and congestive heart failure.

A “similar, but weaker trend” was also seen for ARBs.

“Our study raises many questions for the current COVID-19 pandemic,” wrote lead author Alberto Palazzuoli, MD, PhD, University of Siena in Italy, and colleagues. “Could chronic ACE inhibitor/ARB use be protective against initial infection or reduce the severity of COVID-19 pneumonia? Large population studies including the large fraction of COVID-19 patients who shelter at home and are not hospitalized will need to be performed. Would administration of ACE inhibitor/ARB in hospital be protective against the development of adult respiratory distress syndrome? For this question, daily ACE inhibitor/ARB administration is needed or preferably a randomized trial recruiting hospitalized subjects.”

To answer these questions, and others, the authors said further research is “urgently needed” in this area.

More information on the Journal of the American Heart Association study is available here.

The authors of a similar study from September—this one published in the American Journal of Cardiology—found that statin use prior to hospitalization was associated with less severe COVID-19 symptoms and a faster time to recovery. Read more about those findings here.