Renin-angiotensin-aldosterone system (RAAS) inhibition therapy was effective for reducing mortality in patients critically hospitalized with COVID-19, who had preexisting hypertension, according to study results presented at the American Heart Association (AHA) Scientific Sessions 2021, held from November 13 to 15, 2021.

For the study, researchers examined the role of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) on COVID-19 outcomes in patients admitted to intensive care units (ICU) with preexisting hypertension. Across 354 participating sites in 54 countries, 663 adults with hypertension were admitted to ICU for COVID-related illness from December 2019 through December 2020. Study outcomes were length of stay and in-hospital mortality to 90 days post ICU admission. Cox proportional hazard models and sensitivity analysis were used to determine the influence of ACE inhibitors and ARBs on mortality and discharge rates.

Of 663 total participants, 480 patients received ACE inhibitors and/or ARB therapy within 2 weeks of ICU admission. In patients with angiotensin inhibition, average ICU stays and general ward stays were longer than in the non-angiotensin inhibition group (20.8 and 6.5 days vs 15.5 and 6.0 days). However, use of angiotensin inhibition therapy was associated with reduced mortality (hazard ratio [HR], 0.69; 95% CI, 0.54-0.88), which persisted after adjusting for propensity scores (HR, 0.67; 95% CI, 0.53-0.86).

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The investigators suggested that RAAS inhibition pre-ICU admission was effective for reducing mortality in critically ill patients hospitalized with COVID-19.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Sato K, White N, Fanning JP, et al. Renin-angiotensin-aldosterone system inhibition is associated with reduced in-hospital mortality in critically ill COVID-19 patients with pre-existing hypertension. Presented at: AHA Scientific Sessions 2021; November 13-15, 2021. Poster P713.