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RAAS Blockers and Risk of COVID-19
Quick Takes
- Use of ARBs and ACE inhibitors was more frequent among patients with SARS-CoV-2 than among controls because of their higher prevalence of cardiovascular disease.
- After adjustment for treatment-related covariates and markers of patient clinical status, the use of ARBs or ACE inhibitors was not associated with the risk of COVID-19.
- There was no evidence of an independent association between the use of antihypertensive drugs and the risk of COVID-19.
Study Questions:
What is the association between the use of renin–angiotensin–aldosterone system (RAAS) blockers and the risk of coronavirus disease 2019 (COVID-19)?
Methods:
The investigators conducted a population-based case-control study in the Lombardy region of Italy. A total of 6,272 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 (ORs) and 95% confidence intervals (CIs) for associations between drugs and infection, with adjustment for confounders, were estimated by means of logistic regression. To test the hypothesis that exposure may affect the severity of clinical manifestations of COVID-19, analyses were restricted to the stratum of patients who had a critical or fatal infection.
Results:
Among both case patients and controls, the mean (± standard deviation) 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 OR, 0.95; 95% CI, 0.86-1.05 for ARBs and adjusted OR, 0.96; 95% CI, 0.87-1.07 for ACE inhibitors) or among patients who had a severe or fatal course of the disease (adjusted OR, 0.83; 95% CI, 0.63-1.10 for ARBs and adjusted OR, 0.91; 95% CI, 0.69-1.21 for ACE inhibitors), and no association between these variables was found according to sex.
Conclusions:
The authors concluded that there was no evidence that ACE inhibitors or ARBs affected the risk of COVID-19.
Perspective:
This case-control study reports that the use of ARBs and ACE inhibitors was more frequent among patients with SARS-CoV-2 than among controls matched for age, sex, and place of residence. However, all other major antihypertensive drugs were also used more frequently in patients with COVID-19 because of their higher prevalence of cardiovascular disease. Furthermore, in a multivariable analysis after adjustment for numerous treatment-related covariates and markers of patient clinical status, the use of ARBs or ACE inhibitors was not significantly associated with the risk of COVID-19. Overall, there was no evidence of an independent association between the use of antihypertensive drugs (in which an ACE inhibitor or an ARB is by far the most common component) and the risk of COVID-19.
Clinical Topics: COVID-19 Hub, Heart Failure and Cardiomyopathies, Prevention
Keywords: Angiotensin-Converting Enzyme Inhibitors, Angiotensin II Type 2 Receptor Blockers, Antihypertensive Agents, Cardiovascular Diseases, Coronavirus, COVID-19, Primary Prevention, Renin-Angiotensin System, Risk Assessment, SARS Virus, severe acute respiratory syndrome coronavirus 2, Vascular Diseases
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