The relationship between the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), diabetes mellitus (DM), and the risk of death in patients with COVID-19 remains controversial. We hypothesized that DM and certain characteristics of the COVID-19 course during hospital treatment may alter the assessment of the effect of ACEIs/ARBs on COVID-19 outcomes. The records of 153 COVID-19 inpatients admitted to a municipal clinic in Kyiv, Ukraine, between October and December 2021 were reviewed. To assess the effect of ARBs/ACEIs and other hypotensive drugs, a no hypotensives group was used for comparison. A multivariable logistic regression model was employed to assess the odds ratio (OR) of death. If DM was known at the time of hospitalization (n=28), there was a higher proportion of deaths compared to the group without DM (n=125): 53.6% vs. 12.8%, p < 0.001. After adjusting for age, minimal O2 saturation, DM, and antihypertensive therapy, the ACEIs-associated OR was 0.10 (0.02-0.69). The DM-associated OR was 8.25 (1.92-35.42). The use of ACEIs in the treatment of COVID-19 inpatients is associated with a lower risk of mortality compared to those not using hypotensive treatment, regardless of the presence of DM.

The authors have declared no competing interest.

This study was supported by the National Research Foundation of Ukraine Grant# 2021.01/0213 "Study of the course and consequences of COVID-19 in patients with diabetes mellitus and the impact of SARS-CoV-2 infection on the rate of biological aging"

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This study was approved by the Komisarenko Institute of Endocrinology and Metabolism ethics committee. Owing to the retrospective nature and anonymity of this study, the ethics committee waived the need for written informed consent. Protocol # 35/4-KE from 01/04/2021.

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