AIMS: The role of renin-angiotensin-aldosterone system (RAAS) blockers on the course of coronavirus disease 2019 (COVID-19) is debated . We assessed the association between chronic use of RAAS blockers and mortality among inpatients with COVID-19, and explored reasons for discrepancies in the literature .
METHODS AND RESULTS: We included adult hypertensive patients from a prospective nationwide cohort of 3512 inpatients with COVID-19 up to June 30 , 2020 . Cox proportional hazard models with various adjustment or propensity weighting methods were used to estimate the Hazard Ratios (HR) of 30-day mortality for chronic users versus non-users of RAAS blockers . We analyzed data of 1160 hypertensive patients; 719 (62 %) were male , 777 (67 %) were older than 65 years . The main comorbidities were diabetes (n=416 , 36 %), chronic cardiac disease (n=401 , 35 %) and obesity (n=340 , 29 %); 705 (61 %) received oxygen therapy . We recorded 135 (11.6 %) deaths within 30 days of diagnosis . We found no association between chronic use of RAAS blockers and mortality (unadjusted HR=1.13 , 95% CI [0.8-1.6]; propensity inverse probability treatment weighted HR=1.09 [0.86-1.39]; propensity standardized mortality ratio weighted HR=1.08 [0.79-1.47] ). Our comprehensive review of previous studies highlighted that significant associations were mostly found in unrestricted populations with inappropriate adjustment, or with biased in-hospital exposure measurement .
CONCLUSION: Our results do not support previous concerns regarding these drugs, nor a potential protective effect as reported in previous poorly designed studies and metanalyses . RAAS blockers should not be discontinued during the pandemic, while in-hospital management of these drugs will be clarified by randomized trials . NCT04262921.