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Hypertension, medications, and risk of severe COVID-19: A Massachusetts community-based observational study

Ann Z Bauer1, Rebecca Gore1, Susan R Sama1,2

  • 1Department of Public Health, University of Massachusetts Lowell, Lowell, MA, USA.

Journal of Clinical Hypertension (Greenwich, Conn.)
|November 21, 2020
PubMed

Insights

Hypertension medications like ACE inhibitors and ARBs did not increase severe COVID-19 risk. Cardiovascular comorbidities, however, were linked to worse outcomes, especially in younger patients.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Pharmacology

Background:

  • Uncertainty exists regarding the impact of hypertension medications, specifically ACE inhibitors (ACEi) and angiotensin receptor blockers (ARB), on SARS-CoV-2 infection severity.
  • Pre-existing cardiovascular conditions and diabetes are known risk factors for severe COVID-19.

Purpose of the Study:

  • To evaluate the association between ACEi and ARB use and severe COVID-19 outcomes (hospitalization or mortality).
  • To investigate if age, thiazide diuretic use, or specific health conditions modify these associations.

Main Methods:

  • Observational study of 1449 patients diagnosed with COVID-19 from a Massachusetts group medical practice.
  • Propensity score-matched analyses were used to assess the association of ACEi and ARB with severe COVID-19.
  • Comorbidities, age, and concurrent medication use (e.g., thiazides) were analyzed as potential modifiers.

Main Results:

  • Pre-infection comorbidities (hypertension, cardiovascular disease, diabetes) were associated with increased severe COVID-19 risk, particularly in patients under 65.
  • Neither ACEi (OR=1.30) nor ARB (OR=0.94) use was significantly associated with an increased risk of severe COVID-19 after propensity score matching.
  • Thiazide use did not alter the relationship between ACEi/ARB and COVID-19 severity. Other cardiovascular medications also showed no association with severity.

Conclusions:

  • Cardiovascular comorbidities are significant risk factors for severe COVID-19, especially in younger adults (<65).
  • Patients taking ACE inhibitors or ARBs do not face a substantially increased risk of severe COVID-19.
  • Findings support continuing renin-angiotensin system (RAS) inhibitors for patients with hypertension during the COVID-19 pandemic.

Keywords:
COVID-19angiotensin receptor blockersangiotensin-converting enzyme inhibitorshypertensionrenin-angiotensin system

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