Renin-angiotensin system inhibitors and susceptibility to COVID-19 in patients with hypertension: a propensity score-matched cohort study in primary care.

Haroon, Shamil, Subramanian, Anuradhaa, Cooper, Jennifer, Anand, Astha, Gokhale, Krishna, Byne, Nathan, Dhalla, Samir, Acosta-Mena, Dionisio, Taverner, Thomas, Okoth, Kelvin, Wang, Jingya, Chandan, Joht Singh, Sainsbury, Christopher, Zemedikun, Dawit Tefra, Thomas, G Neil, Parekh, Dhruv, Marshall, Tom, Sapey, Elizabeth, Adderley, Nicola J and Nirantharakumar, Krishnarajah (2021) Renin-angiotensin system inhibitors and susceptibility to COVID-19 in patients with hypertension: a propensity score-matched cohort study in primary care. BMC infectious diseases, 21 (1). p. 262. ISSN 1471-2334. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

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Abstract

INTRODUCTION

Renin-angiotensin system (RAS) inhibitors have been postulated to influence susceptibility to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). This study investigated whether there is an association between their prescription and the incidence of COVID-19 and all-cause mortality.

METHODS

We conducted a propensity-score matched cohort study comparing the incidence of COVID-19 among patients with hypertension prescribed angiotensin-converting enzyme I (ACE) inhibitors or angiotensin II type-1 receptor blockers (ARBs) to those treated with calcium channel blockers (CCBs) in a large UK-based primary care database (The Health Improvement Network). We estimated crude incidence rates for confirmed/suspected COVID-19 in each drug exposure group. We used Cox proportional hazards models to produce adjusted hazard ratios for COVID-19. We assessed all-cause mortality as a secondary outcome.

RESULTS

The incidence rate of COVID-19 among users of ACE inhibitors and CCBs was 9.3 per 1000 person-years (83 of 18,895 users [0.44%]) and 9.5 per 1000 person-years (85 of 18,895 [0.45%]), respectively. The adjusted hazard ratio was 0.92 (95% CI 0.68 to 1.26). The incidence rate among users of ARBs was 15.8 per 1000 person-years (79 out of 10,623 users [0.74%]). The adjusted hazard ratio was 1.38 (95% CI 0.98 to 1.95). There were no significant associations between use of RAS inhibitors and all-cause mortality.

CONCLUSION

Use of ACE inhibitors was not associated with the risk of COVID-19 whereas use of ARBs was associated with a statistically non-significant increase compared to the use of CCBs. However, no significant associations were observed between prescription of either ACE inhibitors or ARBs and all-cause mortality.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: W Public health. Health statistics. Occupational health. Health education
WD Diseases and disorders of systemic, metabolic or environmental origin
WK Endocrine system. Endocrinology
WT Geriatrics. Elderly care
Divisions: Ambulatory Care
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Depositing User: Jamie Edgar
Date Deposited: 25 Mar 2021 15:11
Last Modified: 25 Mar 2021 15:11
URI: http://www.repository.uhblibrary.co.uk/id/eprint/4127

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