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Clin Kidney J
. 2021 Sep 3;15(1):79-94.
doi: 10.1093/ckj/sfab161. eCollection 2022 Jan.
Association of renin-angiotensin system blockers with COVID-19 diagnosis and prognosis in patients with hypertension: a population-based study
María José Soler 1 , Aida Ribera 2 , Josep R Marsal 2 , Ana Belen Mendez 3 , Mireia Andres 3 , Maria Antonia Azancot 1 , Gerard Oristrell 3 , Leonardo Méndez-Boo 4 , Jordana Cohen 5 , Jose A Barrabés 3 , Ignacio Ferreira-González 6 , Vall d’Hebron COVID-19 Working Group
Affiliations
- PMID: 35035939
- PMCID: PMC8499934
- DOI: 10.1093/ckj/sfab161
Abstract
Background: The effect of renin-angiotensin system (RAS) blockade either by angiotensin-converting enzyme inhibitors (ACEis) or angiotensin-receptor blockers (ARBs) on coronavirus disease 2019 (COVID-19) susceptibility, mortality and severity is inadequately described. We examined the association between RAS blockade and COVID-19 diagnosis and prognosis in a large population-based cohort of patients with hypertension (HTN).
Methods: This is a cohort study using regional health records. We identified all individuals aged 18-95 years from 87 healthcare reference areas of the main health provider in Catalonia (Spain), with a history of HTN from primary care records. Data were linked to COVID-19 test results, hospital, pharmacy and mortality records from 1 March 2020 to 14 August 2020. We defined exposure to RAS blockers as the dispensation of ACEi/ARBs during the 3 months before COVID-19 diagnosis or 1 March 2020. Primary outcomes were: COVID-19 infection and severe progression in hospitalized patients with COVID-19 (the composite of need for invasive respiratory support or death). For both outcomes and for each exposure of interest (RAS blockade, ACEi or ARB) we estimated associations in age-, sex-, healthcare area- and propensity score-matched samples.
Results: From a cohort of 1 365 215 inhabitants we identified 305 972 patients with HTN history. Recent use of ACEi/ARBs in patients with HTN was associated with a lower 6-month cumulative incidence of COVID-19 diagnosis {3.78% [95% confidence interval (CI) 3.69-3.86%] versus 4.53% (95% CI 4.40-4.65%); P < 0.001}. In the 12 344 patients with COVID-19 infection, the use of ACEi/ARBs was not associated with a higher risk of hospitalization with need for invasive respiratory support or death [OR = 0.91 (0.71-1.15); P = 0.426].
Conclusions: RAS blockade in patients with HTN is not associated with higher risk of COVID-19 infection or with a worse progression of the disease.
Keywords: COVID-19; angiotensin receptor blockers; angiotensin-converting enzyme; hypertension; mortality; renin–angiotensin system blockers.