tetano
Editor, Senior Moderator
J Clin Hypertens (Greenwich)
. 2020 Nov 21.
doi: 10.1111/jch.14101. Online ahead of print.
Hypertension, medications, and risk of severe COVID-19: A Massachusetts community-based observational study
Ann Z Bauer[SUP] 1 [/SUP], Rebecca Gore[SUP] 1 [/SUP], Susan R Sama[SUP] 1 2 [/SUP], Richard Rosiello[SUP] 2 [/SUP], Lawrence Garber[SUP] 2 [/SUP], Devi Sundaresan[SUP] 2 [/SUP], Anne McDonald[SUP] 2 [/SUP], Patricia Arruda[SUP] 2 [/SUP], David Kriebel[SUP] 1 [/SUP]
Affiliations
Abstract
It remains uncertain whether the hypertension (HT) medications angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) mitigate or exacerbate SARS-CoV-2 infection. We evaluated the association of ACEi and ARB with severe coronavirus disease 19 (COVID-19) as defined by hospitalization or mortality among individuals diagnosed with COVID-19. We investigated whether these associations were modified by age, the simultaneous use of the diuretic thiazide, and the health conditions associated with medication use. In an observational study utilizing data from a Massachusetts group medical practice, we identified 1449 patients with a COVID-19 diagnosis. In our study, pre-infection comorbidities including HT, cardiovascular disease, and diabetes were associated with increased risk of severe COVID-19. Risk was further elevated in patients under age 65 with these comorbidities or cancer. Twenty percent of those with severe COVID-19 compared to 9% with less severe COVID-19 used ACEi, 8% and 4%, respectively, used ARB. In propensity score-matched analyses, use of neither ACEi (OR = 1.30, 95% CI 0.93 to 1.81) nor ARB (OR = 0.94, 95% CI 0.57 to 1.55) was associated with increased risk of severe COVID-19. Thiazide use did not modify this relationship. Beta blockers, calcium channel blockers, and anticoagulant medications were not associated with COVID-19 severity. In conclusion, cardiovascular-related comorbidities were associated with severe COVID-19 outcomes, especially among patients under age 65. We found no substantial increased risk of severe COVID-19 among patients taking antihypertensive medications. Our findings support recommendations against discontinuing use of renin-angiotensin system (RAS) inhibitors to prevent severe COVID-19.
Keywords: COVID-19; angiotensin receptor blockers; angiotensin-converting enzyme inhibitors; hypertension; renin-angiotensin system.
. 2020 Nov 21.
doi: 10.1111/jch.14101. Online ahead of print.
Hypertension, medications, and risk of severe COVID-19: A Massachusetts community-based observational study
Ann Z Bauer[SUP] 1 [/SUP], Rebecca Gore[SUP] 1 [/SUP], Susan R Sama[SUP] 1 2 [/SUP], Richard Rosiello[SUP] 2 [/SUP], Lawrence Garber[SUP] 2 [/SUP], Devi Sundaresan[SUP] 2 [/SUP], Anne McDonald[SUP] 2 [/SUP], Patricia Arruda[SUP] 2 [/SUP], David Kriebel[SUP] 1 [/SUP]
Affiliations
- PMID: 33220171
- DOI: 10.1111/jch.14101
Abstract
It remains uncertain whether the hypertension (HT) medications angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) mitigate or exacerbate SARS-CoV-2 infection. We evaluated the association of ACEi and ARB with severe coronavirus disease 19 (COVID-19) as defined by hospitalization or mortality among individuals diagnosed with COVID-19. We investigated whether these associations were modified by age, the simultaneous use of the diuretic thiazide, and the health conditions associated with medication use. In an observational study utilizing data from a Massachusetts group medical practice, we identified 1449 patients with a COVID-19 diagnosis. In our study, pre-infection comorbidities including HT, cardiovascular disease, and diabetes were associated with increased risk of severe COVID-19. Risk was further elevated in patients under age 65 with these comorbidities or cancer. Twenty percent of those with severe COVID-19 compared to 9% with less severe COVID-19 used ACEi, 8% and 4%, respectively, used ARB. In propensity score-matched analyses, use of neither ACEi (OR = 1.30, 95% CI 0.93 to 1.81) nor ARB (OR = 0.94, 95% CI 0.57 to 1.55) was associated with increased risk of severe COVID-19. Thiazide use did not modify this relationship. Beta blockers, calcium channel blockers, and anticoagulant medications were not associated with COVID-19 severity. In conclusion, cardiovascular-related comorbidities were associated with severe COVID-19 outcomes, especially among patients under age 65. We found no substantial increased risk of severe COVID-19 among patients taking antihypertensive medications. Our findings support recommendations against discontinuing use of renin-angiotensin system (RAS) inhibitors to prevent severe COVID-19.
Keywords: COVID-19; angiotensin receptor blockers; angiotensin-converting enzyme inhibitors; hypertension; renin-angiotensin system.