Losartan linked to risk of hypotension and AKI among COVID-19 patients hospitalized for pneumonia: Study

A recent research by Karen Tran and colleagues suggested that angiotensin receptor blockers (ARBs) should not be added to the treatment of patients hospitalized for acute COVID-19. The findings of this study were published in the recent edition of Clinical Infectious Diseases journal.

COVID-19 resulted in several hospitalizations, ICU admissions and the requirement for life support. The randomized controlled studies used prophylactic anticoagulation, dexamethasone, immune regulators and Janus kinase inhibitors for patients admitted with acute COVID-19 which showed lower ventilation and death rates. This downregulates the angiotensin-converting enzyme 2 of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may lead to an increase in angiotensin II. This study was set out to find if losartan is safe and reduces mortality in hospitalized COVID-19 patients when compared to standard treatment in patients hospitalized with acute COVID-19 infection.

Adults hospitalized with COVID-19 infections were included in this research. The patients with hypotension, hyperkalemia, acute renal damage and use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers during the previous seven days were excluded. The patients from 29 hospitals in France and Canada were randomized to receive standard care (control arm) or losartan 25–100 mg/day orally for the duration of the hospital stay or three months. The 28-day mortality rate was the primary measure. Hospital mortality, organ support, and serious adverse events (SAEs) were considered secondary outcomes.

There was a major safety risk with losartan that led to the early termination of the experiment. Compared to usual care groups, losartan had substantially higher rates of hypotension and any SAE in 341 patients in both intensive care and ward patients. Neither organ dysfunction nor secondary outcomes differed between losartan (6.5%) and usual care (5.9%) in terms of 28-day mortality.

The outcome of this research and the comprehensive literature point to significant safety concerns with the use of losartan and other ARBs in patients who are hospitalized for pneumonia. Overall, losartan did not change mortality or critical organ function when compared to conventional therapy in individuals hospitalized for acute COVID-19 without previous ARB exposure.

Source:

Tran, K. C., Asfar, P., Cheng, M., Demiselle, J., Singer, J., Lee, T., Sweet, D., Boyd, J., Walley, K., Haljan, G., Sharif, O., Geri, G., Auchabie, J., Quenot, J.-P., Lee, T. C., Tsang, J., Meziani, F., Lamontagne, F., … Dubee, V. (2024). Effects of Losartan on Patients Hospitalized for Acute Coronavirus Disease 2019: A Randomized Controlled Trial. In Clinical Infectious Diseases. Oxford University Press (OUP). https://doi.org/10.1093/cid/ciae306