May 1, 2020Open Access
Renin–Angiotensin–Aldosterone System Blockers and the Risk of Covid-19
Key Result
Use of ARBs or ACE inhibitors did not show any association with Covid-19 risk overall (adjusted OR 0.95, 95% CI 0.86-1.05 for ARBs; OR 0.96, 95% CI 0.87-1.07 for ACE inhibitors).
Study Design
Type
Case-Control (n=37,031)
Structured PICO
Does the use of ACE inhibitors or ARBs increase the risk of Covid-19 in the general population?
P
Population
37,031 individuals in Lombardy, Italy, including 6,272 case patients with confirmed SARS-CoV-2 infection and 30,759 matched controls (beneficiaries of the Regional Health Service matched by sex, age, and municipality). Mean age 68±13 years, 37% women.
I
Intervention
Use of angiotensin-receptor blockers (ARBs) or angiotensin-converting-enzyme (ACE) inhibitors
C
Comparator
Matched controls not using these medications
O
Outcome
Risk of Covid-19 (SARS-CoV-2 infection)hard clinical
The use of ACE inhibitors and ARBs is not associated with an increased risk of Covid-19 or a more severe disease course, supporting the continuation of these medications during the pandemic.
Main Result
Effect estimate: OR 0.95 for ARBs, OR 0.96 for ACE inhibitors (95% CI 0.86-1.05 for ARBs, 0.87-1.07 for ACE inhibitors)
Abstract
BACKGROUND: A potential association between the use of angiotensin-receptor blockers (ARBs) and angiotensin-converting-enzyme (ACE) inhibitors and the risk of coronavirus disease 2019 (Covid-19) has not been well studied. METHODS: We carried out a population-based case-control study in the Lombardy region of Italy. A total of 6272 case patients in whom infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed between February 21 and March 11, 2020, were matched to 30, 759 beneficiaries of the Regional Health Service (controls) according to sex, age, and municipality of residence. Information about the use of selected drugs and patients' clinical profiles was obtained from regional databases of health care use. Odds ratios and 95% confidence intervals for associations between drugs and infection, with adjustment for confounders, were estimated by means of logistic regression. RESULTS: Among both case patients and controls, the mean (±SD) age was 68±13 years, and 37% were women. The use of ACE inhibitors and ARBs was more common among case patients than among controls, as was the use of other antihypertensive and non-antihypertensive drugs, and case patients had a worse clinical profile. Use of ARBs or ACE inhibitors did not show any association with Covid-19 among case patients overall (adjusted odds ratio, 0. 95 95% confidence interval CI, 0. 86 to 1. 05 for ARBs and 0. 96 95% CI, 0. 87 to 1. 07 for ACE inhibitors) or among patients who had a severe or fatal course of the disease (adjusted odds ratio, 0. 83 95% CI, 0. 63 to 1. 10 for ARBs and 0. 91 95% CI, 0. 69 to 1. 21 for ACE inhibitors), and no association between these variables was found according to sex. CONCLUSIONS: In this large, population-based study, the use of ACE inhibitors and ARBs was more frequent among patients with Covid-19 than among controls because of their higher prevalence of cardiovascular disease. However, there was no evidence that ACE inhibitors or ARBs affected the risk of COVID-19.