portuguêns Differences in prognosis between hypertenses using ACEI and ARB and others antihypertesive classes with covid-19 in ICU

Abstract

Introduction: hypertensive patients with covid-19 have a worse prognosis. The upregulation of Angiotensin Converting Enzyme 2 due to the use of ACEI/ARBs may justify this: the virus uses it to penetrate the cell. Objective: to compare the prognosis in hypertensive patients with covid-19 using ACEI/ARBs with those using other antihypertensives. Methodology: observational historical cohort study. Were analyzed the medical records of hypertensive adults with covid-19 admitted to the ICU of a reference hospital in the Federal District from March-November 2020. Those with imminent death, malignancy, COPD, CHF, immunosuppression, pregnancy and transferred patients were excluded. Individuals were divided in two: in use of ACEI/ARBs and other antihypertensives. The following were factors for poor prognosis: death, heart or kidney failure, sepsis, disseminated intravascular coagulation, prolonged time on MV and time of hospitalization on ICU. The data was evaluated with SPSS for statistical correlations, considered significant if p < 0.05 and a confidence interval that does not cross 1. Results: of the 60 included, average age was 60.85, 63% were men, average permanence at ICU of 19.98 days. 13.3% use ACEI, 20% ARB, 26.6% combined ARB and ACEI; 13% used other classes and 35% do not treat hipertension or the regimen is unknown. There wasn’t a correlation between the use of ARBs/ACEIs and a worse prognosis. Conclusion: ACEI/ARB are nephroprotectors and
cardioprotective and should be maintained during infection. There are few studies on this topic in ICUs in Brazil, making this one relevant.