Takeaway
- The use of angiotensin-converting enzyme (ACE) inhibitors in hypertensive patients was not associated with an increased risk of suspected or confirmed COVID-19, whereas the use of angiotensin II receptor blockers (ARBs) was associated with a non-significantly increased risk of COVID-19 vs calcium channel blockers (CCBs).
- However, neither of the renin-angiotensin system (RAS) inhibitor classes was associated with a significantly increased risk of all-cause mortality during the first peak of the pandemic.
Why this matters
- The Council on Hypertension of the European Society of Cardiology emphasised the lack of evidence supporting the harmful effects of ACE inhibitors and ARBs in the context of the COVID-19 pandemic.
Study design
- A propensity score-matched cohort study used data from The Health Improvement Network (THIN) database in the UK.
- There were 18,895 patients in each arm of the ACE inhibitor and CCB paired cohorts and 10,623 in each arm of the ARB and CCB paired cohorts.
- Primary outcome was incidence of confirmed/suspected COVID-19 in each drug exposure group; secondary outcome was all-cause mortality.
- Funding: None.
Key results
- The incidence rates of COVID-19 were 9.3 and 9.5 per 1000 person-years in ACE inhibitor users (0.44%) and CCB users (0.45%), respectively (adjusted HR [aHR], 0.92; 95% CI, 0.68-1.26).
- There was a non-significantly increased risk of all-cause mortality between ACE inhibitor and CCB users (aHR, 1.25; 95% CI, 0.90-1.73)
- The incidence rates of COVID-19 were 15.8 and 11.6 per 1000 person-years in ARB users (0.74%) and CCB users (0.55%), respectively (aHR, 1.38; 95% CI, 0.98-1.95).
- No statistically significant difference was observed in all-cause mortality between ARB and CCB users (aHR, 0.85; 95% CI, 0.56-1.30).
Limitations
- Suspected or confirmed COVID-19 may not have been well recorded in primary care records.
This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.
