Renin-Angiotensin System Inhibitors and Susceptibility to COVID-19 in Patients With Hypertension: A Propensity Score-Matched Cohort Study in Primary Care

• Published in: BMC Infectious Diseases
• Main Authors: Haroon, Shamil, Subramanian, Anuradhaa, Cooper, Jennifer, Astha Anand, Gokhale, Krishna, Byne, Nathan, Dhalla, Samir, Acosta-Mena, Dionisio, Taverner, Thomas, Okoth, Kelvin, Wang, Jingya, Joht Singh Chandan, Sainsbury, Christopher, Zemedikun, Dawit Tefra, Thomas, G Neil, Parekh, Dhruv, Marshall, Tom, Sapey, Elizabeth, Adderley, Nicola J, Nirantharakumar, Krishnarajah
• Format: Web Resource
• Language: English
• Published: Durham Research Square 01.12.2020
• Subjects: Coronaviruses; COVID-19; Diuretics; Endocrine system; Hypertension; Mortality; Primary care; Severe acute respiratory syndrome coronavirus 2
• DOI: 10.21203/rs.3.rs-113510/v1

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 ACE inhibitors or 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.