Angiotensin receptor blockers tied to less ventilation, vasopressors in men with COVID-19
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Use of angiotensin receptor blockers was associated with less need for ventilation and vasopressors among men hospitalized with COVID-19, but not in women, according to research presented at the Society of Critical Care Medicine Congress.
Research to date has demonstrated that men have worse COVID-19 outcomes than women, with a similar number of cases and no difference in mortality between sexes, but more hospitalizations and ICU admissions in men, Genevieve Rocheleau, MSc, summer research student at the University of British Columbia Centre for Health Lung Innovation in Critical Care Medicine and second-year medical student at the University of Limerick in Ireland, said during a presentation.
The ARBs CORONA I study was conducted at 10 sites in Canada and enrolled 1,686 patients admitted to the hospital for acute COVID-19 (median age, 67 years; 61% men). Upon enrollment, 18% of patients were taking an angiotensin receptor blocker (ARB), 18% an angiotensin-converting enzyme (ACE) inhibitor and 64% neither an ARB nor ACE inhibitor. Patients presented with comorbidities known to increase risk for severe COVID-19, including hypertension in 53%, diabetes in 33%, chronic cardiac disease in 25% and chronic kidney disease in 14%.
The study was conducted from February 2020 to April 2021 and comprehensively captured the first two waves of the pandemic in Canada, Rocheleau said.
In this cohort, overall outcomes were worse in men than women. There was no difference in in-hospital or 28-day mortality, use of renal replacement therapy or time to hospital discharge. However, men had significantly greater odds of ICU admission (adjusted OR = 1.42; P = .008), need for invasive ventilation (aOR = 1.45; P = .006) and need for vasopressors (aOR = 1.46; P = .005), according to the abstract published in Critical Care Medicine.
When the researchers evaluated outcomes based on ARB use, they found a different need for organ support with ARBs according to sex, Rocheleau said. Men taking ARBs were less likely to need ventilation (P = .006) or vasopressors (P = .044) compared with men not on ARBs, Rocheleau said. The same was not observed in women taking ARBs compared with those not on ARBs, Rocheleau said.
For ACE inhibitors alone, none of these results were significant, according to the results.
“Based on these findings, we conclude that males hospitalized with acute COVID-19 experience greater risk of ICU admission and need for ventilation and need for vasopressors compared to females. We also found that ARB use was associated with less need for ventilation and vasopressors in males but not females,” Rocheleau said. “Perhaps our [results] may help address the sex disparity in outcomes among hospitalized COVID-19 patients.”
Rocheleau said these data demonstrate that further randomized clinical trials of ARBs in hospitalized adults are warranted. ARBs CORONA II, a multinational randomized clinical trial, is underway, she said.