COVID-19 morbidity and mortality associated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers use among 14,129 patients with hypertension from a US integrated healthcare system

• Published in: International Journal of Cardiology Hypertension (Online) Vol. 9; p. 100088
• Main Authors: An, Jaejin, Zhou, Hui, Wei, Rong, Luong, Tiffany Q., Gould, Michael K., Mefford, Matthew T., Harrison, Teresa N., Creekmur, Beth, Lee, Ming-Sum, Sim, John J., Brettler, Jeffrey W., Martin, John P., Ong-Su, Angeline L., Reynolds, Kristi
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.06.2021; Elsevier
• Subjects: Angiotensin converting enzyme inhibitors; Angiotensin receptor blockers; Covid 19; Hypertension; Research Paper; Covid 19; Hypertension; Angiotensin converting enzyme inhibitors; Angiotensin receptor blockers
• ISSN: 2590-0862; 2590-0862
• DOI: 10.1016/j.ijchy.2021.100088

Although recent evidence suggests no increased risk of severe COVID-19 outcomes associated with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) use, the relationship is less clear among patients with hypertension and diverse racial/ethnic groups. This study evaluates the risk of hospitalization and mortality among patients with hypertension and COVID-19 in a large US integrated healthcare system. Patients with hypertension and COVID-19 (between March 1- September 1, 2020) on ACEIs or ARBs were compared with patients on other frequently used antihypertensive medications. Among 14,129 patients with hypertension and COVID-19 infection (mean age 60 years, 48% men, 58% Hispanic), 21% were admitted to the hospital within 30 days of COVID-19 infection. Of the hospitalized patients, 24% were admitted to intensive care units, 17% required mechanical ventilation, and 10% died within 30 days of COVID-19 infection. Exposure to ACEIs or ARBs prior to COVID-19 infection was not associated with an increased risk of hospitalization or all-cause mortality (rate ratios for ACEIs vs other antihypertensive medications ​= ​0.98, 95% CI: 0.88, 1.08; ARBs vs others ​= ​1.00, 95% CI: 0.90, 1.11) after applying inverse probability of treatment weights. These associations were consistent across racial/ethnic groups. Use of ACEIs or ARBs during hospitalization was associated with a lower risk of all-cause mortality (odds ratios for ACEIs or ARBs vs others ​= ​0.50, 95% CI: 0.34, 0.72). Our study findings support continuation of ACEI or ARB use for patients with hypertension during the COVID-19 pandemic and after COVID-19 infection. [Display omitted]