Analysis of the efficacy of ACEI and ARB treatment in COVID-19 patients with hypertension

CHEN Feng; ZOU Rong-rong; WANG Jun

doi:10.13820/j.cnki.gdyx.20224811

Abstract：Objective The efficacy of angiotensin-converting enzyme inhibitors(ACEIs)and angiotensin Ⅱ re-ceptor blockers(ARBs)in the treatment of COVID-19 patients with hypertension remains controversial.This study aimed to explore the therapeutic effects of ACEIs and ARBs in COVID-19 patients with hypertension.Methods A ret-rospective analysis was conducted on COVID-19 patients with hypertension admitted to the hospital.Patients were divid-ed into ACEI/ARB group(n=18)and non-ACEI/ARB group(n=29)based on whether they received ACEI or ARB treatment.Patients were further classified into common and severe types according to disease severity,and clinical charac-teristics,laboratory test results,imaging data,and clinical outcome parameters were compared and analyzed.Results The median age of all patients was 65.0 years(range:57.0-69.0 years),with 57.4％being male.76.6％of patients had a clear history of contact,and the median time from onset to admission was 3.0 days(range:1.0-7.0 days).The most common clinical manifestations were fever(74.5％),cough(48.9％),fatigue(27.7％),and sputum production(25.5％).There were no significant differences in clinical types between the ACEI/ARB group and non-ACEI/ARB group(P＞0.05),and there were no significant differences in baseline clinical characteristics and laboratory test results between the two groups(P＞0.05).In both groups,severe patients had lower lymphocyte counts and higher lactate dehy-drogenase(LDH),C-reactive protein(CRP),interleukin-6(IL-6),procalcitonin(PCT),and D-dimer levels compared to common patients.On the 15th day of illness,severe patients in the non-ACEI/ARB group had higher LDH,CRP,IL-6,PCT,and D-dimer levels compared to those in the ACEI/ARB group,but the differences between the two groups were not significant(P＞0.05).There was one death in the non-ACEI/ARB group,and the rest of the patients in both groups recovered and were discharged after treatment.Among all patients,the duration of fever and time to im-provement on chest computed tomography(CT)were shorter in the ACEI/ARB group compared to the non-ACEI/ARB group,while the length of hospital stay and time to viral nucleic acid conversion were longer in the ACEI/ARB group,but these comparisons were not statistically significant(P＞0.05).Among common patients,the length of hospital stay,time to viral nucleic acid conversion,and time to improvement on chest CT were higher in the ACEI/ARB group compared to the non-ACEI/ARB group,but only the time to viral nucleic acid conversion was significantly different(P＜0.05).Conversely,among severe patients,the duration of fever,length of hospital stay,time to viral nucleic acid conversion,and time to improvement on chest CT were higher in the non-ACEI/ARB group compared to the ACEI/ARB group,but the differences were not statistically significant(P＞0.05).Conclusion ACEI or ARB treatment may shorten the dura-tion of fever,and may have a protective effect on severe COVID-19 patients with hypertension.