COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Etiology Rezel-Potts E, Douiri A, Chowienczyk PJ, et al. Antihypertensive medications and COVID-19 diagnosis and mortality: Population-based case-control analysis in the United Kingdom. Br J Clin Pharmacol. 2021 Apr 27. doi: 10.1111/bcp.14873.

AIMS: Antihypertensive drugs have been implicated in coronavirus disease 2019 (COVID-19) susceptibility and severity, but estimated associations may be susceptible to bias. We aimed to evaluate antihypertensive medications and COVID-19 diagnosis and mortality, accounting for healthcare-seeking behaviour.

METHODS: A population-based case-control study was conducted including 16 866 COVID-19 cases and 70 137 matched controls from the UK Clinical Practice Research Datalink. We evaluated all-cause mortality among COVID-19 cases. Exposures were angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), beta-blockers (B), calcium-channel blockers (C), thiazide diuretics (D) and other antihypertensive drugs (O). Analyses were adjusted for covariates and consultation frequency.

RESULTS: ACEIs were associated with lower odds of COVID-19 diagnosis (adjusted odds ratio [AOR] 0.82, 95% confidence interval [CI] 0.77-0.88) as were ARBs (AOR 0.87, 95% CI 0.80-0.95) with little attenuation from adjustment for consultation frequency. C and D were also associated with lower odds of COVID-19 diagnosis. Increased odds of COVID-19 for B (AOR 1.19, 95% CI 1.12-1.26) were attenuated after adjustment for consultation frequency (AOR 1.01, 95% CI 0.95-1.08). Patients treated with ACEIs or ARBs had similar odds of mortality (AOR 1.00, 95% CI 0.83-1.20) to patients treated with classes B, C, D or O or patients receiving no antihypertensive therapy (AOR 0.99, 95% CI 0.83-1.18).

CONCLUSIONS: There was no evidence that antihypertensive therapy is associated with increased risk of COVID-19 diagnosis or mortality; most classes of antihypertensive therapy showed negative associations with COVID-19 diagnosis.

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

Cardiology rater

I believe we can’t correlate antihypertensive drugs to COVID-19. Just an observation.

Family Medicine (FM)/General Practice (GP) rater

This is one of the increasingly frequent investigations into a possible relationship between antihypertensive therapy and severity of COVID-19 infection. The individual observations on the different antihypertensive drugs are certainly not sufficiently powered for strong statements.

Hospital Doctor/Hospitalists rater

Great study that clears many misconceptions related to COVID-19.

Hospital Doctor/Hospitalists rater

This article researched the risks of mortality in patients using multiple classes of antihypertensive agents in the setting of COVID-19. Since hypertension is the risk factor for two leading causes of death in the United States, proper evidence of the safety profiles of the antihypertensive medications at the times of SARS-CoV-2 discovery, is essential.

Infectious Disease rater

Another analysis, this time of ~17,000 patients with COVID-19 and ~70,000 controls in the UK Clinical Practice Research Datalink showing no increase in diagnosis of COVID-19 or death associated with prescription of an antihypertensive agent.