Association of renin-angiotensin system blockers with COVID-19 diagnosis and prognosis in patients with hypertension : a population-based study
Soler, María José (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Ribera, A (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Marsal, Josep Ramon (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Méndez, Ana Belen (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Andrés Villareal, Mireia (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Azancot, María A (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Oristrell, Gerard (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Méndez-Boo, Leonardo (Institut Català de la Salut)
Cohen, Jordana (University of Pennsylvania)
Barrabés, José A (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Ferreira-Gonzalez, Ignacio (Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública)
Universitat Autònoma de Barcelona

Data:	2021
Resum:	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). 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. 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]. RAS blockade in patients with HTN is not associated with higher risk of COVID-19 infection or with a worse progression of the disease.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Angiotensin-converting enzyme ; Angiotensin receptor blockers ; COVID-19 ; Hypertension ; Mortality ; Renin-angiotensin system blockers
Publicat a:	Clinical Kidney Journal, Vol. 15 (september 2021) , p. 79-94, ISSN 2048-8513

DOI: 10.1093/ckj/sfab161
PMID: 35035939

16 p, 4.1 MB

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