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RAAS Inhibitors and Risk of COVID-19
Quick Takes
- There were no substantially higher risks of severe COVID-19 associated with ACE inhibitors, ARBs, beta-blockers, calcium channel blockers, or thiazide diuretics.
- The study specifically did not find any adverse effects of use of RAAS blockers on the likelihood of a positive test for COVID-19 or on the likelihood of severe COVID-19 among those with a positive test.
- Available data should help alleviate concerns from patients and providers regarding continued use of these agents in patients undergoing testing or receiving treatment for COVID-19.
Study Questions:
What is the association between the use of antihypertensive medications and the likelihood of a positive test for coronavirus disease 2019 (COVID-19) as well as the likelihood of severe COVID-19 (defined as intensive care, mechanical ventilation, or death)?
Methods:
The investigators assessed the relation between previous treatment with angiotensin-converting enzyme (ACE) inhibitors, angiotensin-receptor blockers (ARBs), beta-blockers, calcium channel blockers, or thiazide diuretics and the likelihood of a positive or negative result on COVID-19 testing as well as the likelihood of severe illness (defined as intensive care, mechanical ventilation, or death) among patients who tested positive. Using Bayesian methods, they compared outcomes in patients who had been treated with these medications and in untreated patients, overall and in those with hypertension, after propensity-score matching for receipt of each medication class. A difference of ≥10 percentage points was prespecified as a substantial difference.
Results:
Among 12,594 patients who were tested for COVID-19, a total of 5,894 (46.8%) were positive; 1,002 of these patients (17.0%) had severe illness. A history of hypertension was present in 4,357 patients (34.6%), among whom 2,573 (59.1%) had a positive test; 634 of these patients (24.6%) had severe illness. There was no association between any single medication class and an increased likelihood of a positive test. None of the medications examined was associated with a substantial increase in the risk of severe illness among patients who tested positive.
Conclusions:
The authors concluded that there was no substantial increase in the likelihood of a positive test for COVID-19 or in the risk of severe COVID-19 among patients who tested positive in association with common classes of antihypertensive medications.
Perspective:
This observational cohort study reports no substantially higher risk (by ≥10 percentage points) of severe COVID-19 associated with any of the antihypertensive medications (ACE inhibitors, ARBs, beta-blockers, calcium channel blockers, or thiazide diuretics) studied. The study specifically did not find any adverse effects of use of medications that act on renin–angiotensin–aldosterone system (RAAS) pathways on the likelihood of a positive test for COVID-19 among patients who were tested or on the likelihood of severe COVID-19 among those with a positive test. These and other available data should help alleviate concerns from patients and providers regarding the continued use of these agents in patients undergoing testing or receiving treatment for COVID-19.
Clinical Topics: COVID-19 Hub, Heart Failure and Cardiomyopathies, Prevention, Hypertension
Keywords: Adrenergic beta-Antagonists, Angiotensin-Converting Enzyme Inhibitors, Antihypertensive Agents, Calcium Channel Blockers, Coronavirus, COVID-19, Hypertension, Intensive Care, Peptidyl-Dipeptidase A, Primary Prevention, Renin-Angiotensin System, Sodium Chloride Symporter Inhibitors, Vascular Diseases, Ventilators, Mechanical
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