COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

COVID-19 Evidence Alerts needs your support. If our service is of value to you, please consider donating to keep it going. Learn more Donate now

Etiology Dublin S, Walker R, Floyd JS, et al. Renin-angiotensin-aldosterone system inhibitors and COVID-19 infection or hospitalization: a cohort study. Am J Hypertens. 2020 Oct 13. pii: 5922320. doi: 10.1093/ajh/hpaa168.

BACKGROUND: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may increase the risk of COVID-19 infection or affect disease severity. Prior studies have not examined the association of medication dose with risks.

METHODS: This retrospective cohort study included people aged =18 years enrolled in a US integrated healthcare system for at least 4 months as of 2/29/2020. Current ACEI and ARB use was identified from pharmacy data, and the estimated daily dose was calculated and standardized across medications. COVID-19 infections and hospitalizations were identified through 6/14/2020 from laboratory and hospitalization data. We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals, adjusting for race/ethnicity, obesity and other covariates.

RESULTS: Among 322,044 individuals, 826 developed COVID-19 infection. Among people using ACEI/ARBs, 204/56,105 developed COVID-19 (3.6 per 1000 individuals) compared with 622/265,939 without ACEI/ARB use (2.3 per 1000), yielding an adjusted OR of 0.91 (95% CI 0.74-1.12). For use of < 1 defined daily dose vs. nonuse, the adjusted OR for infection was 0.92 (95% CI 0.66-1.28); for 1 to < 2 defined daily doses, 0.89 (95% CI 0.66-1.19); and for =2 defined daily doses, 0.92 (95% CI 0.72-1.18). The OR was similar for ACEIs and ARBs and in subgroups by age and sex. 26% of people with COVID-19 infection were hospitalized; the adjusted OR for hospitalization in relation to ACEI/ARB use was 0.98 (95% CI 0.63-1.54), and there was no association with dose.

CONCLUSIONS: These findings support current recommendations that individuals on these medications continue their use.

Discipline / Specialty Area Score
Hospital Doctor/Hospitalists
Internal Medicine
Infectious Disease
Family Medicine (FM)/General Practice (GP)
General Internal Medicine-Primary Care(US)