Abstract
Patients With Obesity-Related Hypertension Treated With Renin-Angiotensin-Aldosterone System Antagonists Exhibit Lower Mortality And Less Severe COVID-19: A Retrospective Study
Journal of the Endocrine Society, Vol.5(Suppl 1), pp.A296-A296
05/03/2021
DOI: 10.1210/jendso/bvab048.601
PMCID: PMC8090405
Abstract
Background:
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has been found to exploit the cell’s ACE2 receptor for viral entry. Renin-angiotensin-aldosterone system (RAAS) antagonism with angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) increases the expression of ACE2 receptors which, coupled with the metabolic changes associated with obesity-related hypertension, can make hypertensive patients with obesity more vulnerable to severe COVID-19. Although current evidence suggests that ACEI/ARB use does not increase risk of severe COVID-19 in the general population, potential interactions with obesity-related hypertension are unknown.
Methods:
We conducted a retrospective study of COVID-19 patients admitted to the University of Iowa Hospitals and Clinics between March 1st and July 8th, 2020. We included adults who are overweight (BMI ≥ 25 kg/m
2
) or obese (BMI ≥ 30 kg/m
2
) with hypertension treated as outpatients with or without ACEIs/ARBs. Patients without exposure to RAAS antagonists served as controls. We assessed mortality and the severity of COVID-19 reflected by admission to ICU and usage of supplemental O
2
, non-invasive ventilation, mechanical ventilation, extracorporeal membrane oxygenation (ECMO) and vasopressors.
Results:
Of the 369 inpatients with COVID-19, we identified 138 exhibiting obesity-related hypertension who were then allocated into the control (n=59) and ACEI/ARB (n=79) groups. The BMIs between groups at baseline were not statistically significant (
Control
: 33.6 ± 0.96 vs. ACEI/ARB: 34.99 ± 0.97; p=.32). Women were less represented in the ACEI/ARB group (
Control
: 47% vs.
ACEI/ARB
: 24%). The controls had a substantially higher mortality rate (
Control
: 32.2% vs.
ACEI/ARB
: 15.1%). In regard to the severity of COVID-19, the ACEI/ARB cohort showed lower usage of supplemental O
2
(
Control
: 52.5% vs.
ACEI/ARB
: 49.3%), mechanical ventilation (
Control
: 37.2% vs.
ACEI/ARB
: 1.2%), vasopressors (
Control
: 38.9% vs.
ACEI/ARB
: 31.6%), and had lower ICU admissions (
Control
: 57.6% vs.
ACEI/ARB
: 46.8%). However, the ACEI/ARB group had higher rates of: ECMO (
Control
: 0% vs.
ACEI/ARB
: 20.2%) and non-invasive ventilation (
Control
: 18.6% vs.
ACEI/ARB
: 20.2%). Of note, the rate of diabetes was higher in the ACEI/ARB cohort (
Control
: 45.7% vs.
ACEI/ARB
: 63.2%).
Conclusion:
Our results suggest that a history of RAAS antagonism is associated with lower mortality and less severity of COVID-19 in patients with obesity-related hypertension requiring hospital admission.
Details
- Title: Subtitle
- Patients With Obesity-Related Hypertension Treated With Renin-Angiotensin-Aldosterone System Antagonists Exhibit Lower Mortality And Less Severe COVID-19: A Retrospective Study
- Creators
- Vijayvardhan Kamalumpundi - University of IowaElham Shams - University of IowaLinhai Cheng - University of IowaAdeyinka Taiwo - University of IowaAmal A Shibli-Rahhal - University of IowaAyotunde O Dokun - University of IowaMarcelo Correia - University of Iowa
- Resource Type
- Abstract
- Publication Details
- Journal of the Endocrine Society, Vol.5(Suppl 1), pp.A296-A296
- DOI
- 10.1210/jendso/bvab048.601
- PMCID
- PMC8090405
- ISSN
- 2472-1972
- eISSN
- 2472-1972
- Publisher
- Oxford University Press
- Language
- English
- Date published
- 05/03/2021
- Academic Unit
- Molecular Physiology and Biophysics; Fraternal Order of Eagles Diabetes Research Center; Medicine Administration; Endocrinology and Metabolism; Internal Medicine
- Record Identifier
- 9984302186802771
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