Renin–Angiotensin–Aldosterone System Inhibitors and Risk of Covid-19

TLDR

Concern exists that medications acting on the renin‑angiotensin‑aldosterone system may increase COVID‑19 risk because the virus uses ACE2 as a receptor. The study evaluated whether prior use of ACE inhibitors, ARBs, beta‑blockers, calcium‑channel blockers, or thiazide diuretics affected COVID‑19 test positivity or severe disease among patients who tested positive. The authors used Bayesian analysis with propensity‑score matched cohorts to compare outcomes between patients on each medication class and untreated patients, overall and among hypertensive individuals. No single antihypertensive class was associated with a higher chance of testing positive or with a substantial increase in severe COVID‑19 risk.

Abstract

There is concern about the potential of an increased risk related to medications that act on the renin-angiotensin-aldosterone system in patients exposed to coronavirus disease 2019 (Covid-19), because the viral receptor is angiotensin-converting enzyme 2 (ACE2).We assessed the relation between previous treatment with ACE inhibitors, angiotensin-receptor blockers, beta-blockers, calcium-channel blockers, or thiazide diuretics and the likelihood of a positive or negative result on Covid-19 testing as well as the likelihood of severe illness (defined as intensive care, mechanical ventilation, or death) among patients who tested positive. Using Bayesian methods, we compared outcomes in patients who had been treated with these medications and in untreated patients, overall and in those with hypertension, after propensity-score matching for receipt of each medication class. A difference of at least 10 percentage points was prespecified as a substantial difference.Among 12,594 patients who were tested for Covid-19, a total of 5894 (46.8%) were positive; 1002 of these patients (17.0%) had severe illness. A history of hypertension was present in 4357 patients (34.6%), among whom 2573 (59.1%) had a positive test; 634 of these patients (24.6%) had severe illness. There was no association between any single medication class and an increased likelihood of a positive test. None of the medications examined was associated with a substantial increase in the risk of severe illness among patients who tested positive.We found no substantial increase in the likelihood of a positive test for Covid-19 or in the risk of severe Covid-19 among patients who tested positive in association with five common classes of antihypertensive medications.