PT  - JOURNAL ARTICLE
AU  - Khodneva, Yulia
AU  - Malla, Gargya
AU  - Clarkson, Stephen
AU  - Fu, Richard
AU  - Safford, Monika M
AU  - Goyal, Parag
AU  - Oparil, Suzanne
AU  - Cherrington, Andrea L
AU  - Jackson, Elizabeth A
AU  - Willig, James
TI  - What is the association of renin–angiotensin–aldosterone system inhibitors with COVID-19 outcomes: retrospective study of racially diverse patients?
AID  - 10.1136/bmjopen-2021-053961
DP  - 2022 Apr 01
TA  - BMJ Open
PG  - e053961
VI  - 12
IP  - 4
4099  - http://bmjopen.bmj.com/content/12/4/e053961.short
4100  - http://bmjopen.bmj.com/content/12/4/e053961.full
SO  - BMJ Open2022 Apr 01; 12
AB  - Objective To describe the clinical outcomes of COVID-19 in a racially diverse sample from the US Southeast and examine the association of renin–angiotensin–aldosterone system (RAAS) inhibitor use with COVID-19 outcome.Design, Setting, Participants This study is a retrospective cohort of 1024 patients with reverse-transcriptase PCR-confirmed COVID-19 infection, admitted to a 1242-bed teaching hospital in Alabama. Data on RAAS inhibitors use, demographics and comorbidities were extracted from hospital medical records.Primary outcomes In-hospital mortality, a need of intensive care unit, respiratory failure, defined as invasive mechanical ventilation (iMV) and 90-day same-hospital readmissions.Results Among 1024 patients (mean (SD) age, 57 (18.8) years), 532 (52.0%) were African Americans, 514 (50.2%) male, 493 (48.1%) had hypertension, 365 (36%) were taking RAAS inhibitors. During index hospitalisation (median length of stay of 7 (IQR (4–15) days) 137 (13.4%) patients died; 170 (19.2%) of survivors were readmitted. RAAS inhibitor use was associated with lower in-hospital mortality (adjusted HR, 95% CI (0.56, (0.36 to 0.88), p=0.01) and no effect modification by race was observed (p for interaction=0.81). Among patients with hypertension, baseline RAAS use was associated with reduced risk of iMV, adjusted OR, 95% CI (aOR 0.58, 95% CI 0.36 to 0.95, p=0.03). Patients with heart failure were twice as likely to die from COVID-19, compared with patients without heart failure.Conclusions In a retrospespective study of racially diverse patients, hospitalised with COVID-19, prehospitalisation use of RAAS inhibitors was associated with 40% reduction in mortality irrespective of race.Data are available on reasonable request. All data relevant to the study are available from the corresponding author on request.