This study examined whether certain blood pressure medications, called renin-angiotensin system (RAS) inhibitors, influence the risk of getting COVID-19 or dying from any cause. Researchers compared patients with hypertension who used ACE inhibitors or ARBs to those using calcium channel blockers (CCBs). They found that the risk of getting COVID-19 was similar for users of ACE inhibitors and CCBs. However, users of ARBs had a slightly higher risk of COVID-19, although this was not statistically significant. There were no significant differences in all-cause mortality between users of RAS inhibitors and CCBs. The study suggests that ACE inhibitors do not increase the risk of COVID-19, while the impact of ARBs remains unclear.

Abstract

Introduction

Renin-angiotensin system (RAS) inhibitors have been postulated to influence susceptibility to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). This study investigated whether there is an association between their prescription and the incidence of COVID-19 and all-cause mortality.

Methods

We conducted a propensity-score matched cohort study comparing the incidence of COVID-19 among patients with hypertension prescribed angiotensin-converting enzyme I (ACE) inhibitors or angiotensin II type-1 receptor blockers (ARBs) to those treated with calcium channel blockers (CCBs) in a large UK-based primary care database (The Health Improvement Network). We estimated crude incidence rates for confirmed/suspected COVID-19 in each drug exposure group. We used Cox proportional hazards models to produce adjusted hazard ratios for COVID-19. We assessed all-cause mortality as a secondary outcome.

Results

The incidence rate of COVID-19 among users of ACE inhibitors and CCBs was 9.3 per 1000 person-years (83 of 18,895 users [0.44%]) and 9.5 per 1000 person-years (85 of 18,895 [0.45%]), respectively. The adjusted hazard ratio was 0.92 (95% CI 0.68 to 1.26). The incidence rate among users of ARBs was 15.8 per 1000 person-years (79 out of 10,623 users [0.74%]). The adjusted hazard ratio was 1.38 (95% CI 0.98 to 1.95). There were no significant associations between use of RAS inhibitors and all-cause mortality.

Conclusion

Use of ACE inhibitors was not associated with the risk of COVID-19 whereas use of ARBs was associated with a statistically non-significant increase compared to the use of CCBs. However, no significant associations were observed between prescription of either ACE inhibitors or ARBs and all-cause mortality.

Authors: Shamil Haroon , Anuradhaa Subramanian , Jennifer Cooper , Astha Anand , Krishna Gokhale , Nathan Byne , Samir Dhalla , Dionisio Acosta-Mena , Thomas Taverner , Kelvin Okoth  Jingya Wang , Joht Singh Chandan , Christopher Sainsbury , Dawit Tefra Zemedikun , G Neil Thomas , Dhruv Parekh , Tom Marshall , Elizabeth Sapey , Nicola J Adderley , Krishnarajah Nirantharakumar