Correlation of In-Hospital Antihypertensive Therapy with Clinical Outcomes in Hypertensive Patients Admitted with COVID-19: A Retrospective Single-Centre Study in South Africa

Background and study aim: Hypertension has been associated with severe COVID-19 manifestations and increased mortality rates, particularly in low- and middle-income countries. This study aimed to elucidate the impact of inpatient antihypertensive therapy on COVID-19 outcomes among hypertensive patients in a predominantly black population in South Africa, focusing on the role of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs).Patients and Methods: A retrospective analysis was conducted at King Edward VIII Hospital, South Africa, encompassing hypertensive patients hospitalised with laboratory-confirmed SARS-CoV-2 infection from June 2020 to December 2021. Data on demographics, comorbidities, antihypertensive therapy, clinical signs, laboratory markers, and outcomes were analysed. Statistical methods included univariate and multivariate logistic regression to identify predictors of mortality.Results: The study included 205 hypertensive patients with COVID-19, of whom 115 received ACEI/ARB therapy. Patients on ACEI/ARBs exhibited significantly lower requirements for oxygen therapy, steroid therapy, and mechanical ventilation. Notably, ACEI/ARB therapy was associated with a significant reduction in mortality (aOR=0.144, p<0.001), higher median oxygen saturation (p=0.002), and lower inflammatory markers on presentation (p<0.05). Conversely, initial findings suggested an increased mortality risk with calcium channel blocker use (OR=2.783, p=0.001), which did not remain significant after adjusting for confounders (aOR=1.388, p=0.544).Conclusion: ACEI/ARB use was associated with improved outcomes in hypertensive patients hospitalised with COVID-19 in a predominantly black population in South Africa. These findings support the continuation of ACEI/ARB therapy in hypertensive patients with COVID-19. Further research is warranted to explore the mechanisms underlying these associations and to validate these findings in larger, prospective studies.