# ACE Inhibitor/ARB Therapy and Other Risk Factors for COVID-19 Infection in Elderly Hypertensive Patients: Sub-Group Analysis Based on a Single-Center, Retrospective, Observational Study in Japan

## TL;DR

This study found that higher serum creatinine and lower serum chloride levels are risk factors for COVID-19 in elderly Japanese patients with hypertension, but ACE inhibitor or ARB use is not.

## Contribution

The study provides evidence that ACEI/ARB use is not linked to increased or decreased risk of COVID-19 in elderly hypertensive patients.

## Key findings

- Higher serum creatinine was independently associated with increased risk of COVID-19.
- Lower serum chloride levels were linked to a higher risk of COVID-19.
- ACE inhibitor and ARB use showed no significant association with COVID-19 risk.

## Abstract

Background: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are often used in hypertensive patients. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the coronavirus disease 2019 (COVID-19) pandemic, binds the ACE2 receptor on the cell surface. This study aimed to identify the risk factors influencing COVID-19 infection in hypertensive patients. Methods: This is a part of a single-center, retrospective, observational study investigating patients ≥ 20 years old at Kenwakai Hospital (Nagano, Japan). COVID-19 was diagnosed by polymerase chain reaction. All patients received antihypertensive drugs. Results: Among 316 patients (mean age, 75.0 ± 13.4 years; men, 55.1%), COVID-19 was diagnosed in 39 (12.3%). Multiple logistic regression analysis after adjustment for age, sex, and smoking status identified increased serum creatinine (Scr) as a significant risk factor for COVID-19 (odds ratio [OR] 1.10; 95% confidence interval [CI] 1.00–1.20; p = 0.046). Conversely, lower serum chloride was associated with COVID-19 (OR 0.92; 95% CI 0.85–0.99; p = 0.047). There was no significant association between COVID-19 and the use of ACEIs and ARBs. Conclusions: Scr was independently associated with COVID-19 risk, whereas ACEI/ARB use was not associated with COVID-19 risk in Japanese hypertensive patients, suggesting that these users need not discontinue or change their treatment. The study population included a very high proportion of patients with advanced chronic kidney disease, which makes the cohort substantially different from the general hypertensive population. However, our results can help guide targeted treatment strategies, improving patient outcomes in healthcare settings.