Renin--angiotensin system inhibitor is associated with the reduced risk of all-cause mortality in COVID-19 among patients with/without hypertension

Consecutively hospitalized patients with confirmed coronavirus disease 2019(COVID-19)in Wuhan,China were retrospectively enrolled from January 2020 to March 2020 to investigate the association between the use of renin–angiotensin system inhibitor(RAS-I)and the outcome of this disease.Associations between the use of RAS-I(angiotensin-converting enzyme inhibitor(ACEI)or angiotensin receptor blocker(ARB)),ACEI,and ARB and in-hospital mortality were analyzed using multivariate Cox proportional hazards regression models in overall and subgroup of hypertension status.A total of 2771 patients with COVID-19 were included,with moderate and severe cases accounting for 45.0%and 36.5%,respectively.A total of 195(7.0%)patients died.RAS-I(hazard ratio(HR)=0.499,95%confidence interval(CI)0.325–0.767)and ARB(HR=0.410,95%CI 0.240–0.700)use was associated with a reduced risk of all-cause mortality among patients with COVID-19.For patients with hypertension,RAS-I and ARB applications were also associated with a reduced risk of mortality with HR of 0.352(95%CI 0.162–0.764)and 0.279(95%CI 0.115–0.677),respectively.RAS-I exhibited protective effects on the survival outcome of COVID-19.ARB use was associated with a reduced risk of all-cause mortality among patients with COVID-19.