Background: The uncertainty about COVID-19 outcomes in angiotensin-converting enzyme inhibitors (ACEI) /angiotensin receptor blockers (ARB) users continues with contradictory findings . This study aimed to determine the effect of ACEI/ARB use in patients with severe COVID-19.
Methods: This retrospective cohort study was done in two Saudi public specialty hospitals designated as COVID-19 referral facilities . We included 354 patients with a confirmed diagnosis of COVID-19 between April and June 2020, of which 146 were ACEI/ARB users and 208 were non-ACEI/ARB users . Controlling for confounders, we conducted multivariate logistic regression and sensitivity analyses using propensity score matching (PSM) and Inverse propensity score weighting (IPSW) for high-risk patient subsets .
Results: Compared to non-ACEI/ARB users, ACEI/ARB users had an eight-fold higher risk of developing critical or severe COVID-19 (OR = 8.25 , 95% CI = 3.32-20.53); a nearly 7-fold higher risk of intensive care unit (ICU) admission (OR = 6.76 , 95% CI = 2.88-15.89) and a nearly 5-fold higher risk of requiring noninvasive ventilation (OR = 4.77,95% CI = 2.15-10.55). Patients with diabetes, hypertension, and/or renal disease had a five-fold higher risk of severe COVID-19 disease (OR = 5.40,95% CI = 2.0-14.54]. These results were confirmed in the PSM and IPSW analyses . Conclusion: In general, but especially among patients with hypertension, diabetes, and/or renal disease, ACEI/ARB use is associated with a significantly higher risk of severe or critical COVID-19 disease, and ICU care.