Renin-Angiotensin-Aldosterone System Inhibitors and COVID-19 Infection or Hospitalization: A Cohort Study

Am J Hypertens. 2021 Apr 20;34(4):339-347. doi: 10.1093/ajh/hpaa168.

Abstract

Background: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may increase the risk of coronavirus disease 2019 (COVID-19) infection or affect disease severity. Prior studies have not examined risks by medication dose.

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 (CIs), 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 1,000 individuals) compared with 622/265,939 without ACEI/ARB use (2.3 per 1,000), yielding an adjusted OR of 0.91 (95% CI 0.74-1.12). For use of <1 defined daily dose (DDD) vs. nonuse, the adjusted OR for infection was 0.92 (95% CI 0.66-1.28); for 1 to <2 DDDs, 0.89 (95% CI 0.66-1.19); and for ≥2 DDDs, 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.

Keywords: COVID-19; angiotensin receptor blocker; angiotensin-converting enzyme inhibitor; blood pressure; coronavirus; hospitalization; hypertension; infection.

MeSH terms

  • Angiotensin Receptor Antagonists* / administration & dosage
  • Angiotensin Receptor Antagonists* / adverse effects
  • Angiotensin-Converting Enzyme Inhibitors* / administration & dosage
  • Angiotensin-Converting Enzyme Inhibitors* / adverse effects
  • COVID-19* / epidemiology
  • COVID-19* / therapy
  • Cohort Studies
  • Comorbidity
  • Dose-Response Relationship, Drug*
  • Drug Monitoring / methods
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Hypertension* / drug therapy
  • Hypertension* / epidemiology
  • Hypertension* / metabolism
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Assessment
  • SARS-CoV-2 / isolation & purification
  • Severity of Illness Index
  • United States / epidemiology

Substances

  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors