Renin-Angiotensin-Aldosterone axis inhibition improves outcome of diabetic patients with chronic hypertension and COVID-19: An Iranian perspective

Safe use of drugs such as angiotensin‑converting enzyme 2 (ACE2) inhibitors and angiotensin receptor blockers (ARBs) in COVID diabetic patients needs comprehensive studies. This study addressed this issue from the Iranian perspective.

Admitted COVID‑19 patients were divided into four groups in this historical cohort study. Group 1 included 740 non‑diabetic, non‑hypertensive patients. Group 2 included 132 non‑hypertensive diabetic patients. Group 3 included 154 non‑diabetic hypertensive patients. Group 4 included 183 diabetic patients who were under ACE inhibitors or ARBs. Death, intensive care unit (ICU) admission, and length of hospitalization were compared between the groups.

After considering associated factors such as age, gender, dyslipidemia, cardiovascular diseases, rheumatoid arthritis (RA), chronic kidney disease (CKD), history of surgery, and corticosteroid use, diabetic patients (group 2) were associated with increased mortality (CI 95%, OR 1.93 [1.11–3.33]). Presence of diabetes (group 2) and hypertension were associated with an increased need for ICU admission (CI 95%, OR 1.69 [1.04–2.76]; CI 95%, OR 1.71 [1.08–2.71], respectively). Group 4 patients although having a similar rate of ICU admission with group 2 and 3 patients, had significantly better ICU survival.

The current study suggests that ACE inhibitors and ARBs are associated with decreased mortality, ICU admission, and better ICU survival in the diabetic subgroup of hypertensive patients.