tetano
Editor, Senior Moderator
PLoS One
. 2021 Apr 23;16(4):e0248080.
doi: 10.1371/journal.pone.0248080. eCollection 2021.
Angiotensin II receptor blocker or angiotensin-converting enzyme inhibitor use and COVID-19-related outcomes among US Veterans
Catherine G Derington[SUP] 1 [/SUP], Jordana B Cohen[SUP] 2 3 [/SUP], April F Mohanty[SUP] 4 5 [/SUP], Tom H Greene[SUP] 1 [/SUP], James Cook[SUP] 4 5 [/SUP], Jian Ying[SUP] 1 4 [/SUP], Guo Wei[SUP] 4 [/SUP], Jennifer S Herrick[SUP] 1 4 [/SUP], Vanessa W Stevens[SUP] 1 4 [/SUP], Barbara E Jones[SUP] 4 5 [/SUP], Libo Wang[SUP] 6 [/SUP], Alexander R Zheutlin[SUP] 5 [/SUP], Andrew M South[SUP] 7 8 [/SUP], Thomas C Hanff[SUP] 9 [/SUP], Steven M Smith[SUP] 10 [/SUP], Rhonda M Cooper-DeHoff[SUP] 10 11 [/SUP], Jordan B King[SUP] 1 12 [/SUP], G Caleb Alexander[SUP] 13 [/SUP], Dan R Berlowitz[SUP] 14 15 [/SUP], Faraz S Ahmad[SUP] 16 [/SUP], M Jason Penrod[SUP] 5 [/SUP], Rachel Hess[SUP] 1 5 [/SUP], Molly B Conroy[SUP] 1 5 [/SUP], James C Fang[SUP] 6 [/SUP], Michael A Rubin[SUP] 4 5 [/SUP], Srinivasan Beddhu[SUP] 5 [/SUP], Alfred K Cheung[SUP] 5 [/SUP], Weiming Xian[SUP] 15 17 [/SUP], William S Weintraub[SUP] 18 [/SUP], Adam P Bress[SUP] 1 4 [/SUP]
Affiliations
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.
. 2021 Apr 23;16(4):e0248080.
doi: 10.1371/journal.pone.0248080. eCollection 2021.
Angiotensin II receptor blocker or angiotensin-converting enzyme inhibitor use and COVID-19-related outcomes among US Veterans
Catherine G Derington[SUP] 1 [/SUP], Jordana B Cohen[SUP] 2 3 [/SUP], April F Mohanty[SUP] 4 5 [/SUP], Tom H Greene[SUP] 1 [/SUP], James Cook[SUP] 4 5 [/SUP], Jian Ying[SUP] 1 4 [/SUP], Guo Wei[SUP] 4 [/SUP], Jennifer S Herrick[SUP] 1 4 [/SUP], Vanessa W Stevens[SUP] 1 4 [/SUP], Barbara E Jones[SUP] 4 5 [/SUP], Libo Wang[SUP] 6 [/SUP], Alexander R Zheutlin[SUP] 5 [/SUP], Andrew M South[SUP] 7 8 [/SUP], Thomas C Hanff[SUP] 9 [/SUP], Steven M Smith[SUP] 10 [/SUP], Rhonda M Cooper-DeHoff[SUP] 10 11 [/SUP], Jordan B King[SUP] 1 12 [/SUP], G Caleb Alexander[SUP] 13 [/SUP], Dan R Berlowitz[SUP] 14 15 [/SUP], Faraz S Ahmad[SUP] 16 [/SUP], M Jason Penrod[SUP] 5 [/SUP], Rachel Hess[SUP] 1 5 [/SUP], Molly B Conroy[SUP] 1 5 [/SUP], James C Fang[SUP] 6 [/SUP], Michael A Rubin[SUP] 4 5 [/SUP], Srinivasan Beddhu[SUP] 5 [/SUP], Alfred K Cheung[SUP] 5 [/SUP], Weiming Xian[SUP] 15 17 [/SUP], William S Weintraub[SUP] 18 [/SUP], Adam P Bress[SUP] 1 4 [/SUP]
Affiliations
- PMID: 33891615
- DOI: 10.1371/journal.pone.0248080
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.