Abstract
It remains uncertain whether the hypertension (HT) medications angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) mitigate or exacerbate SARS-CoV-2 infection. We evaluated the association of ACEi and ARB with severe coronavirus disease 19 (COVID-19) as defined by hospitalization or mortality among individuals diagnosed with COVID-19. We investigated whether these associations were modified by age, the simultaneous use of the diuretic thiazide, and the health conditions associated with medication use. In an observational study utilizing data from a Massachusetts group medical practice, we identified 1449 patients with a COVID-19 diagnosis. In our study, pre-infection comorbidities including HT, cardiovascular disease, and diabetes were associated with increased risk of severe COVID-19. Risk was further elevated in patients under age 65 with these comorbidities or cancer. Twenty percent of those with severe COVID-19 compared to 9% with less severe COVID-19 used ACEi, 8% and 4%, respectively, used ARB. In propensity score-matched analyses, use of neither ACEi (OR = 1.30, 95% CI 0.93 to 1.81) nor ARB (OR = 0.94, 95% CI 0.57 to 1.55) was associated with increased risk of severe COVID-19. Thiazide use did not modify this relationship. Beta blockers, calcium channel blockers, and anticoagulant medications were not associated with COVID-19 severity. In conclusion, cardiovascular-related comorbidities were associated with severe COVID-19 outcomes, especially among patients under age 65. We found no substantial increased risk of severe COVID-19 among patients taking antihypertensive medications. Our findings support recommendations against discontinuing use of renin-angiotensin system (RAS) inhibitors to prevent severe COVID-19.
Keywords: COVID-19; angiotensin receptor blockers; angiotensin-converting enzyme inhibitors; hypertension; renin-angiotensin system.
【저자키워드】 COVID-19, hypertension, Angiotensin receptor blockers, renin-angiotensin system, angiotensin-converting enzyme inhibitors, 【초록키워드】 Mortality, severe COVID-19, Hospitalization, SARS-COV-2 infection, severity, Cancer, Comorbidity, cardiovascular disease, medications, RAS, renin-angiotensin system, ARB, outcomes, Patient, COVID-19 diagnosis, Beta, age, receptor, medication, inhibitor, association, Angiotensin-converting enzyme, angiotensin receptor blocker, angiotensin-converting enzyme inhibitor, Support, 95% CI, increased risk, severe coronavirus disease, individual, blockers, health condition, recommendation, mitigate, Prevent, defined, investigated, evaluated, elevated, less, Massachusett, analyses, modify, diabete, exacerbate, anticoagulant medication, diagnosed with COVID-19, remains uncertain, Thiazide, with COVID-19, 【제목키워드】 risk, medications, Massachusett,