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The influence of ACE inhibitors and ARBs on hospital length of stay and survival in people with COVID-19

Research output: Contribution to journalArticle

Philip Braude, Ben Carter, Roxanna Short, Arturo Vilches-Moraga, Alessia Verduri, Lyndsay Pearce, Angeline Price, Terry J. Quinn, Michael J Stechman, Jemima T. Collins, Eilidh Bruce, Alice Einarsson, Emma Mitchell, Mark Holloway, James Hesford, Fenella Barlow-Pay, Enrico Clini, Susan Moug, Kathryn McCarthy, Jonathan Hewitt

Original languageEnglish
JournalIJC Heart & Vasculature
Accepted/In press9 Oct 2020

King's Authors


During the first few months of the COVID-19 pandemic the continuation or cessation of renin-angiotensin-aldosterone inhibitors has been contentious. Mechanisms have been proposed for both beneficial and detrimental effects of these drugs on the inpatient journey. Recent studies have focused on mortality associated with angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB). None have examined the length of hospital stay outcome. The aim of this study was to determine the influence of ACEi and ARB on COVID-19 mortality and time to discharge.

The COVID-19 in Older People (COPE) study is a multicenter observational study including patients over 18 years old admitted with either laboratory or clinically confirmed COVID-19. Routinely generated hospital data were collected. In this interim analysis the primary outcome was mortality and secondary outcomes included Day-7 mortality and time to discharge (herein described as length of stay). A multivariable Cox’s proportional baseline hazards model and logistic equivalent, were used to analyse time to outcome (death or discharge) and Day-7 mortality.

1371 patients were included from eleven centres between 27th February to 25th April 2020. The median age was 74 years [IQR 61-83]. 28.6% of patients were taking an ACEi or ARB. For those prescribed an ACEi or ARB hospital length of stay was significantly reduced (aHR=1.25, 95%CI 1.02-1.54, p=0.03) and mortality was not altered (aHR=0.85, 95%CI 0.65-1.11). In patients with hypertension, an improvement in Day-7 mortality (aOR=0.69; 95%CI 0.43-0.93;p=0.02) and a stronger effect in reduced hospital stay was seen (aHR=1.39; 95%CI 1.09-1.77;p=0.007). Risk factors for COVID-19 adverse outcome included renal impairment, older age and elevated CRP.

Patients and clinicians can be reassured that continuation of an ACEi or ARB in COVID-19 is safe. The benefit of prescription of an ACEi or ARB in reducing length of hospital stay is a new finding. In addition, in hypertensive patients a reduction in mortality at Day-7 was recorded. These results do not endorse the indiscriminate prescription of an ACEi or ARB as protective drugs in COVID-19.

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