Association of Angiotensin‐Converting Enzyme Inhibitors and Angiotensin Receptor Blockers With the Risk of Hospitalization and Death in Hypertensive Patients With COVID‐19
Background Despite its clinical significance, the risk of severe infection requiring hospitalization among outpatients with severe acute respiratory syndrome coronavirus 2 infection who receive angiotensin‐converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) remains uncertain....
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.018086 |
| _version_ | 1797936085696774144 |
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| author | Rohan Khera Callahan Clark Yuan Lu Yinglong Guo Sheng Ren Brandon Truax Erica S. Spatz Karthik Murugiah Zhenqiu Lin Saad B. Omer Deneen Vojta Harlan M. Krumholz |
| author_facet | Rohan Khera Callahan Clark Yuan Lu Yinglong Guo Sheng Ren Brandon Truax Erica S. Spatz Karthik Murugiah Zhenqiu Lin Saad B. Omer Deneen Vojta Harlan M. Krumholz |
| author_sort | Rohan Khera |
| collection | DOAJ |
| description | Background Despite its clinical significance, the risk of severe infection requiring hospitalization among outpatients with severe acute respiratory syndrome coronavirus 2 infection who receive angiotensin‐converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) remains uncertain. Methods and Results In a propensity score–matched outpatient cohort (January–May 2020) of 2263 Medicare Advantage and commercially insured individuals with hypertension and a positive outpatient SARS‐CoV‐2, we determined the association of ACE inhibitors and ARBs with COVID‐19 hospitalization. In a concurrent inpatient cohort of 7933 hospitalized with COVID‐19, we tested their association with in‐hospital mortality. The robustness of the observations was assessed in a contemporary cohort (May–August). In the outpatient study, neither ACE inhibitors (hazard ratio [HR], 0.77; 0.53–1.13, P=0.18) nor ARBs (HR, 0.88; 0.61–1.26, P=0.48) were associated with hospitalization risk. ACE inhibitors were associated with lower hospitalization risk in the older Medicare group (HR, 0.61; 0.41–0.93, P=0.02), but not the younger commercially insured group (HR, 2.14; 0.82–5.60, P=0.12; P‐interaction 0.09). Neither ACE inhibitors nor ARBs were associated with lower hospitalization risk in either population in the validation cohort. In the primary inpatient study cohort, neither ACE inhibitors (HR, 0.97; 0.81–1.16; P=0.74) nor ARBs (HR, 1.15; 0.95–1.38, P=0.15) were associated with in‐hospital mortality. These observations were consistent in the validation cohort. Conclusions ACE inhibitors and ARBs were not associated with COVID‐19 hospitalization or mortality. Despite early evidence for a potential association between ACE inhibitors and severe COVID‐19 prevention in older individuals, the inconsistency of this observation in recent data argues against a role for prophylaxis. |
| first_indexed | 2024-04-10T18:24:11Z |
| format | Article |
| id | doaj.art-21a4c215d14f4f7e972caa3b5de918ed |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-10T18:24:11Z |
| publishDate | 2021-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-21a4c215d14f4f7e972caa3b5de918ed2023-02-02T06:18:05ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-07-01101310.1161/JAHA.120.018086Association of Angiotensin‐Converting Enzyme Inhibitors and Angiotensin Receptor Blockers With the Risk of Hospitalization and Death in Hypertensive Patients With COVID‐19Rohan Khera0Callahan Clark1Yuan Lu2Yinglong Guo3Sheng Ren4Brandon Truax5Erica S. Spatz6Karthik Murugiah7Zhenqiu Lin8Saad B. Omer9Deneen Vojta10Harlan M. Krumholz11Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CTResearch & Development at UnitedHealth Group Minnetonka MN UASSection of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CTResearch & Development at UnitedHealth Group Minnetonka MN UASResearch & Development at UnitedHealth Group Minnetonka MN UASResearch & Development at UnitedHealth Group Minnetonka MN UASSection of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CTSection of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CTSection of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CTSection of Infectious Diseases Department of Internal Medicine Yale School of Medicine New Haven CTResearch & Development at UnitedHealth Group Minnetonka MN UASSection of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CTBackground Despite its clinical significance, the risk of severe infection requiring hospitalization among outpatients with severe acute respiratory syndrome coronavirus 2 infection who receive angiotensin‐converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) remains uncertain. Methods and Results In a propensity score–matched outpatient cohort (January–May 2020) of 2263 Medicare Advantage and commercially insured individuals with hypertension and a positive outpatient SARS‐CoV‐2, we determined the association of ACE inhibitors and ARBs with COVID‐19 hospitalization. In a concurrent inpatient cohort of 7933 hospitalized with COVID‐19, we tested their association with in‐hospital mortality. The robustness of the observations was assessed in a contemporary cohort (May–August). In the outpatient study, neither ACE inhibitors (hazard ratio [HR], 0.77; 0.53–1.13, P=0.18) nor ARBs (HR, 0.88; 0.61–1.26, P=0.48) were associated with hospitalization risk. ACE inhibitors were associated with lower hospitalization risk in the older Medicare group (HR, 0.61; 0.41–0.93, P=0.02), but not the younger commercially insured group (HR, 2.14; 0.82–5.60, P=0.12; P‐interaction 0.09). Neither ACE inhibitors nor ARBs were associated with lower hospitalization risk in either population in the validation cohort. In the primary inpatient study cohort, neither ACE inhibitors (HR, 0.97; 0.81–1.16; P=0.74) nor ARBs (HR, 1.15; 0.95–1.38, P=0.15) were associated with in‐hospital mortality. These observations were consistent in the validation cohort. Conclusions ACE inhibitors and ARBs were not associated with COVID‐19 hospitalization or mortality. Despite early evidence for a potential association between ACE inhibitors and severe COVID‐19 prevention in older individuals, the inconsistency of this observation in recent data argues against a role for prophylaxis.https://www.ahajournals.org/doi/10.1161/JAHA.120.018086angiotensin receptor blockersangiotensin‐converting enzyme inhibitorsCOVID‐19hypertension |
| spellingShingle | Rohan Khera Callahan Clark Yuan Lu Yinglong Guo Sheng Ren Brandon Truax Erica S. Spatz Karthik Murugiah Zhenqiu Lin Saad B. Omer Deneen Vojta Harlan M. Krumholz Association of Angiotensin‐Converting Enzyme Inhibitors and Angiotensin Receptor Blockers With the Risk of Hospitalization and Death in Hypertensive Patients With COVID‐19 Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease angiotensin receptor blockers angiotensin‐converting enzyme inhibitors COVID‐19 hypertension |
| title | Association of Angiotensin‐Converting Enzyme Inhibitors and Angiotensin Receptor Blockers With the Risk of Hospitalization and Death in Hypertensive Patients With COVID‐19 |
| title_full | Association of Angiotensin‐Converting Enzyme Inhibitors and Angiotensin Receptor Blockers With the Risk of Hospitalization and Death in Hypertensive Patients With COVID‐19 |
| title_fullStr | Association of Angiotensin‐Converting Enzyme Inhibitors and Angiotensin Receptor Blockers With the Risk of Hospitalization and Death in Hypertensive Patients With COVID‐19 |
| title_full_unstemmed | Association of Angiotensin‐Converting Enzyme Inhibitors and Angiotensin Receptor Blockers With the Risk of Hospitalization and Death in Hypertensive Patients With COVID‐19 |
| title_short | Association of Angiotensin‐Converting Enzyme Inhibitors and Angiotensin Receptor Blockers With the Risk of Hospitalization and Death in Hypertensive Patients With COVID‐19 |
| title_sort | association of angiotensin converting enzyme inhibitors and angiotensin receptor blockers with the risk of hospitalization and death in hypertensive patients with covid 19 |
| topic | angiotensin receptor blockers angiotensin‐converting enzyme inhibitors COVID‐19 hypertension |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.018086 |
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