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

Sascha Dublin1,2, Rod L Walker1, James S Floyd1,2,3

  • 1Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA.

American Journal of Hypertension
|October 13, 2020
PubMed

Insights

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) do not increase the risk of COVID-19 infection or hospitalization, regardless of medication dose. These findings support continued use of ACEIs and ARBs for patients.

Area of Science:

  • Cardiovascular Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are commonly prescribed cardiovascular medications.
  • Previous research has raised concerns about potential links between ACEIs/ARBs and increased risk or severity of coronavirus disease 2019 (COVID-19).
  • The impact of medication dosage on these potential risks has not been thoroughly investigated.

Purpose of the Study:

  • To investigate the association between the use of ACEIs and ARBs and the risk of COVID-19 infection.
  • To examine whether medication dose influences the risk of COVID-19 infection or hospitalization.
  • To provide evidence-based recommendations for patients taking ACEIs and ARBs during the COVID-19 pandemic.

Main Methods:

  • Retrospective cohort study of over 322,000 individuals in a US healthcare system.
  • ACEI and ARB use and standardized daily doses were determined from pharmacy data.
  • COVID-19 infection and hospitalization data were collected through June 2020; logistic regression was used for analysis.

Main Results:

  • No significant association was found between ACEI/ARB use and COVID-19 infection (adjusted OR 0.91; 95% CI 0.74-1.12).
  • Medication dose did not alter the risk of infection; adjusted ORs for infection ranged from 0.89 to 0.92 across different dose categories.
  • No association was observed between ACEI/ARB use and COVID-19 hospitalization (adjusted OR 0.98; 95% CI 0.63-1.54).

Conclusions:

  • Current use of ACEIs and ARBs is not associated with an increased risk of COVID-19 infection or hospitalization.
  • These findings support existing clinical guidelines recommending the continuation of ACEIs and ARBs for patients.
  • The study provides reassurance regarding the safety of these medications in the context of the COVID-19 pandemic.
Abstract

Keywords:
COVID-19angiotensin receptor blockerangiotensin-converting enzyme inhibitorblood pressurecoronavirushospitalizationhypertensioninfection

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