Key result
Recent use of ACEi/ARBs in patients with hypertension was associated with lower COVID-19 incidence (3.78% vs 4.53%) and no increased risk of severe progression (OR 0.91; 95% CI 0.71-1.15; P=0.426).
Why the study?
The effect of renin-angiotensin system blockade by ACE inhibitors or ARBs on COVID-19 susceptibility, mortality, and severity was inadequately described.
Does recent use of ACEi/ARBs increase the risk of COVID-19 infection or severe progression in patients with hypertension?
Cohort (n=305,972)
Yes
Does recent use of ACEi/ARBs increase the risk of COVID-19 infection or severe progression in patients with hypertension?
Odds Ratio: 0.91 (95% CI 0.71–1.15)
Absolute Event Rate: 3.78% vs 4.53%
p-value: p=0.426
In patients with hypertension, the use of ACE inhibitors or ARBs is not associated with an increased risk of COVID-19 infection or worse clinical progression, supporting the continuation of these therapies.
ACEi/ARB use was not linked to worse COVID-19 outcomes; observational data leaves open causal safety conclusions for hypertension.
BACKGROUND: The effect of renin-angiotensin system (RAS) blockade either by angiotensin-converting enzyme inhibitors (ACEis) or angiotensin-receptor blockers (ARBs) on coronavirus disease 2019 (COVID-19) susceptibility, mortality and severity is inadequately described. We examined the association between RAS blockade and COVID-19 diagnosis and prognosis in a large population-based cohort of patients with hypertension (HTN). METHODS: This is a cohort study using regional health records. We identified all individuals aged 18-95 years from 87 healthcare reference areas of the main health provider in Catalonia (Spain), with a history of HTN from primary care records. Data were linked to COVID-19 test results, hospital, pharmacy and mortality records from 1 March 2020 to 14 August 2020. We defined exposure to RAS blockers as the dispensation of ACEi/ARBs during the 3 months before COVID-19 diagnosis or 1 March 2020. Primary outcomes were: COVID-19 infection and severe progression in hospitalized patients with COVID-19 (the composite of need for invasive respiratory support or death). For both outcomes and for each exposure of interest (RAS blockade, ACEi or ARB) we estimated associations in age-, sex-, healthcare area- and propensity score-matched samples. RESULTS: From a cohort of 1 365 215 inhabitants we identified 305 972 patients with HTN history. Recent use of ACEi/ARBs in patients with HTN was associated with a lower 6-month cumulative incidence of COVID-19 diagnosis {3.78% [95% confidence interval (CI) 3.69-3.86%] versus 4.53% (95% CI 4.40-4.65%); P < 0.001}. In the 12 344 patients with COVID-19 infection, the use of ACEi/ARBs was not associated with a higher risk of hospitalization with need for invasive respiratory support or death [OR = 0.91 (0.71-1.15); P = 0.426]. CONCLUSIONS: RAS blockade in patients with HTN is not associated with higher risk of COVID-19 infection or with a worse progression of the disease.
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Soler et al. (2021) conducted a cohort in Hypertension and COVID-19 (n=305,972). Renin-angiotensin system (RAS) blockers (ACEi/ARBs) vs. Propensity score-matched controls without recent ACEi/ARB use was evaluated on COVID-19 infection and severe progression in hospitalized patients with COVID-19 (the composite of need for invasive respiratory support or death) (OR 0.91, 95% CI 0.71-1.15, p=0.426). Recent use of ACEi/ARBs in patients with hypertension was associated with lower COVID-19 incidence (3.78% vs 4.53%) and no increased risk of severe progression (OR 0.91; 95% CI 0.71-1.15; P=0.426).
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