1. Angiotensin II receptor blocker or angiotensin-converting enzyme inhibitor use and COVID-19-related outcomes among US Veterans
- Author
-
Libo Wang, M. Jason Penrod, James L. Cook, Weiming Xian, Alfred K. Cheung, Jordana B. Cohen, Guo Wei, Vanessa W. Stevens, Alexander R. Zheutlin, Jennifer S. Herrick, Molly B. Conroy, Rhonda M. Cooper-DeHoff, April F. Mohanty, Andrew M South, Faraz S. Ahmad, Dan R. Berlowitz, G. Caleb Alexander, Jian Ying, Michael Rubin, Barbara E. Jones, Thomas C. Hanff, Tom Greene, Rachel Hess, Catherine G. Derington, Adam P. Bress, Srinivasan Beddhu, Jordan B. King, James C. Fang, William S. Weintraub, and Steven M. Smith
- Subjects
RNA viruses ,Male ,Viral Diseases ,Angiotensin receptor ,Coronaviruses ,Epidemiology ,Angiotensin-Converting Enzyme Inhibitors ,030204 cardiovascular system & hematology ,law.invention ,Medical Conditions ,0302 clinical medicine ,Randomized controlled trial ,Risk Factors ,law ,Outpatients ,Medicine and Health Sciences ,Medicine ,030212 general & internal medicine ,Pathology and laboratory medicine ,Virus Testing ,Veterans ,Multidisciplinary ,biology ,Hazard ratio ,Drugs ,Medical microbiology ,Middle Aged ,Hospitals ,Hospitalization ,Survival Rate ,Intensive Care Units ,Infectious Diseases ,Viruses ,Hypertension ,Female ,SARS CoV 2 ,Pathogens ,Research Article ,medicine.medical_specialty ,Patients ,SARS coronavirus ,Science ,Microbiology ,Angiotensin Receptor Antagonists ,03 medical and health sciences ,Diagnostic Medicine ,Internal medicine ,Humans ,cardiovascular diseases ,Propensity Score ,Survival rate ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Pharmacology ,Inpatients ,Biology and life sciences ,SARS-CoV-2 ,business.industry ,Proportional hazards model ,Organisms ,Viral pathogens ,COVID-19 ,Correction ,Covid 19 ,Angiotensin-converting enzyme ,Retrospective cohort study ,Microbial pathogens ,Health Care ,Health Care Facilities ,Medical Risk Factors ,Propensity score matching ,biology.protein ,business ,Antihypertensives - Abstract
Background Angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) may positively or negatively impact outcomes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We investigated the association of ARB or ACEI use with coronavirus disease 2019 (COVID-19)-related outcomes in US Veterans with treated hypertension using an active comparator design, appropriate covariate adjustment, and negative control analyses. Methods and findings In this retrospective cohort study of Veterans with treated hypertension in the Veterans Health Administration (01/19/2020-08/28/2020), we compared users of (A) ARB/ACEI vs. non-ARB/ACEI (excluding Veterans with compelling indications to reduce confounding by indication) and (B) ARB vs. ACEI among (1) SARS-CoV-2+ outpatients and (2) COVID-19 hospitalized inpatients. The primary outcome was all-cause hospitalization or mortality (outpatients) and all-cause mortality (inpatients). We estimated hazard ratios (HR) using propensity score-weighted Cox regression. Baseline characteristics were well-balanced between exposure groups after weighting. Among outpatients, there were 5.0 and 6.0 primary outcomes per 100 person-months for ARB/ACEI (n = 2,482) vs. non-ARB/ACEI (n = 2,487) users (HR 0.85, 95% confidence interval [CI] 0.73–0.99, median follow-up 87 days). Among outpatients who were ARB (n = 4,877) vs. ACEI (n = 8,704) users, there were 13.2 and 14.8 primary outcomes per 100 person-months (HR 0.91, 95%CI 0.86–0.97, median follow-up 85 days). Among inpatients who were ARB/ACEI (n = 210) vs. non-ARB/ACEI (n = 275) users, there were 3.4 and 2.0 all-cause deaths per 100 person months (HR 1.25, 95%CI 0.30–5.13, median follow-up 30 days). Among inpatients, ARB (n = 1,164) and ACEI (n = 2,014) users had 21.0 vs. 17.7 all-cause deaths, per 100 person-months (HR 1.13, 95%CI 0.93–1.38, median follow-up 30 days). Conclusions This observational analysis supports continued ARB or ACEI use for patients already using these medications before SARS-CoV-2 infection. The novel beneficial association observed among outpatients between users of ARBs vs. ACEIs on hospitalization or mortality should be confirmed with randomized trials.
- Published
- 2021