RAAS Antagonism Reduces COVID-19 Severity in Obesity-Related Hypertension

Senior man measuring his blood pressure at home
Researchers investigated the effects of RAAS antagonism on the severity of COVID-19 in patients with obesity-related hypertension.

The following article is part of our coverage of the Endocrine Society’s annual meeting (ENDO 2021) that is being held virtually from March 20-23, 2021. Endocrinology Advisor‘s staff will report on the top research in hormone science and clinical care. Check back for the latest news from ENDO 2021.


A history of renin-angiotensin-aldosterone system (RAAS) antagonism may be associated with less severe coronavirus disease 2019 (COVID-19) among patients with obesity-related hypertension that requires hospitalization, according to research recently presented at the annual meeting of the Endocrine Society (ENDO) 2021 conference, held virtually from March 20 to 23, 2021.

This retrospective study included 138 inpatients with COVID-19 admitted between March 1 and July 8, 2020. All participants had hypertension, were classified as either overweight (body mass index [BMI] ≥25 kg/m2) or obese (BMI ≥30 kg/m2), and were treated as outpatients with or without angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs).

The control group (n=59) was composed of individuals who had not been exposed to RAAS antagonists, while the larger cohort (n=79) was composed of those treated with ACEIs/ARBs. The ACEI/ARB cohort contained 24% women, compared with 47% in the control group. The ACEI/ARB cohort also had a higher rate of diabetes (ACEI/ARB 63.2%; control 45.7%).

Researchers assessed both severity and mortality of COVID-19 by the use of noninvasive and mechanical ventilation, extracorporeal membrane oxygenation (ECMO), supplemental oxygen, and vasopressors. Compared with the ACEI/ARB group, the control group exhibited higher mortality (ACEI/ARB 15.1%; control 32.2%) and intensive care unit admissions (ACEI/ARB 46.8%; control 57.6%), as well as higher use of mechanical ventilation (ACEI/ARB 1.2%; control 37.2%), vasopressors (ACEI/ARB 31.6%; control 38.9%), and supplemental oxygen (ACEI/ARB 49.3%; control 52.5%). However, the control group had lower rates of both noninvasive ventilation (ACEI/ARB 20.2%; control 18.6%) and ECMO (ACEI/ARB 20.2%; control 0%).

The study authors concluded that the severity and mortality of COVID-19 are lower among those individuals with obesity-related hypertension and a history of RAAS antagonism who required hospitalization.

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Kamalumpundi V, Shams E, Cheng L, et al. Patients with obesity-related hypertension treated with renin-angiotensin-aldosterone system antagonists exhibit lower mortality and less severe COVID-19: a retrospective study. Poster presented at: Endocrine Society (ENDO) 2021 virtual conference; March 20-23, 2021. Session P12.