Temporal variation, socioeconomic status, and out‐of‐hospital deaths as factors that influence mortality rates among hospitalized COVID‐19 patients receiving ACEIs/ARBs

• Published in: The journal of clinical hypertension (Greenwich, Conn.) Conn.), 2022-04, Vol.24 (4), p.519-520
• Main Authors: Aftab, Owais M., Modak, Anurag, Patel, Jai C.
• Format: Article
• Language: English
• Subjects: Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; COVID-19; Disease transmission; Enzymes; Hospitalization; Hospitals; Humans; Hypertension; Letter to the Editor; Mortality; Pandemics; Social Class; Socioeconomic factors
• ISSN: 1524-6175; 1751-7176
• DOI: 10.1111/jch.14473

2 In fact, in-hospital mortality rates decreased in the US over the course of 2020 from March to November, even after adjusting for age, sex, comorbidites, and disease severity at admission. 2 As such, a retrospective analysis during this time period would be strengthened by accounting for this variation. Data from India's first COVID-19 surge in October 2020 noted that infected individuals were protected from severe manifestations of the disease and experienced reduced mortality rates compared to Western nations due to cross-immunity from other pathogens, which was confirmed serologically. 3 More generally, it has been found that less-developed nations with a higher burden of pediatric mortality as well as mortality from preventable disease had lower rates of COVID-19 mortality. 4 Furthermore, cultural differences between countries may play a role in the severity of the pandemic's impact; even prior to the COVID-19 pandemic, countries with individualistic cultures may be at greater risk for an increase in outbreaks and transmission of infectious diseases when compared to collectivist cultures. 5 The authors did not control for continuation or discontinuation of the ACEIs/ARBs after discharge from the hospital. A French study established a causal link between out-of-hospital cardiac arrest or out-of-hospital sudden death and COVID-19 in the early pandemic, during March to April 2020 and some Indian studies found an increase in mortality associated with the administration of ACEIs/ARBs in hospitalized COVID-19 patients in the early phase of the pandemic. 6–8 However, a randomized controlled trial in Brazil found a non-significant difference in mortality rates between the 30-day continuation and 30-day discontinuation groups. 9 Although the results of the Brazilian study concord with the results of Jia et al., the clinical trial did not account for the same comorbidities as the retrospective study, so the authors of the present study missed an opportunity to more rigorously establish evidence in favor of use routine use of ACEIs/ARBs in hospitalized COVID-19 patients with hypertension. 9 Despite these limitations, the findings of the systematic review discussed does warrant further investigation, especially as the full breadth of COVID-19-related side-effects is currently not understood.