is prior use of renin-angiotensin system (ras) inhibitors associated with more favourable outcome in covid-19 hospitalized patients?

Objective: we aimed to investigate the extent of pulmonary involvement and adverse outcomes in patients receiving angiotensin-converting enzyme inhibitor (acei)/ angiotensin ii receptor blocker (arb) versus who did not, in hospitalized coronavirus infectious disease 2019 (covid-19) patients. method: all covid-19 patients with a positive polymerase chain reaction (pcr) test, who were admitted to our tertiary referral hospitals in tehran, iran between january 2021 and may 2021, and had an on-admission chest computed tomography (ct) scan, were included. the patients were divided into two groups (receiving acei/arb and who did not) for further analysis. the outcomes of interest in our study were the extent of pulmonary involvement, intensive care unit (icu) admission, and death. results: a total of 893 participants (mean age of 58.6±15.4 years; female, 522 (58.4%)) were enrolled. among them, 368 (41.2%) participants had hypertension, and use of acei/arb was reported in 183 (20.5%) participants. of all, 409 (45.8%) participants required icu admission, and 259 (29%) participants succumbed to death. we found that participants who received acei/arb were less likely to progress critical disease and experienced significantly lower icu admission (p=0.022) and death (p<0.001). on multivariable analysis adjusting for age, sex, and comorbidities, this relationship remained statistically significant for death (odds ratio (or): 0.23 [0.14- 0.38], p<0.001) and icu admission (or: 0.49 [0.32-0.73], p=0.001). conclusion: our findings showed that covid-19 patients who receiving acei/arb prior to hospitalization vs. those who did not, had more favorable outcomes.