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Association of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers With the Risk of Hospitalization and Death in Hypertensive Patients With COVID-19.
- Source :
-
Journal of the American Heart Association [J Am Heart Assoc] 2021 Jul 06; Vol. 10 (13), pp. e018086. Date of Electronic Publication: 2021 Feb 24. - Publication Year :
- 2021
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Abstract
- Background Despite its clinical significance, the risk of severe infection requiring hospitalization among outpatients with severe acute respiratory syndrome coronavirus 2 infection who receive angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) remains uncertain. Methods and Results In a propensity score-matched outpatient cohort (January-May 2020) of 2263 Medicare Advantage and commercially insured individuals with hypertension and a positive outpatient SARS-CoV-2, we determined the association of ACE inhibitors and ARBs with COVID-19 hospitalization. In a concurrent inpatient cohort of 7933 hospitalized with COVID-19, we tested their association with in-hospital mortality. The robustness of the observations was assessed in a contemporary cohort (May-August). In the outpatient study, neither ACE inhibitors (hazard ratio [HR], 0.77; 0.53-1.13, P =0.18) nor ARBs (HR, 0.88; 0.61-1.26, P =0.48) were associated with hospitalization risk. ACE inhibitors were associated with lower hospitalization risk in the older Medicare group (HR, 0.61; 0.41-0.93, P =0.02), but not the younger commercially insured group (HR, 2.14; 0.82-5.60, P =0.12; P -interaction 0.09). Neither ACE inhibitors nor ARBs were associated with lower hospitalization risk in either population in the validation cohort. In the primary inpatient study cohort, neither ACE inhibitors (HR, 0.97; 0.81-1.16; P =0.74) nor ARBs (HR, 1.15; 0.95-1.38, P =0.15) were associated with in-hospital mortality. These observations were consistent in the validation cohort. Conclusions ACE inhibitors and ARBs were not associated with COVID-19 hospitalization or mortality. Despite early evidence for a potential association between ACE inhibitors and severe COVID-19 prevention in older individuals, the inconsistency of this observation in recent data argues against a role for prophylaxis.
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
COVID-19 complications
COVID-19 therapy
Cohort Studies
Female
Hospital Mortality
Humans
Hypertension drug therapy
Male
Middle Aged
Propensity Score
Young Adult
Angiotensin Receptor Antagonists therapeutic use
Angiotensin-Converting Enzyme Inhibitors therapeutic use
COVID-19 mortality
Hospitalization
Hypertension complications
Hypertension mortality
Subjects
Details
- Language :
- English
- ISSN :
- 2047-9980
- Volume :
- 10
- Issue :
- 13
- Database :
- MEDLINE
- Journal :
- Journal of the American Heart Association
- Publication Type :
- Academic Journal
- Accession number :
- 33624516
- Full Text :
- https://doi.org/10.1161/JAHA.120.018086