COVID-19 research briefs: Antihypertensive use not associated with an increased risk of SARS-CoV-2 infection

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Published: 2020-05-17 © 2020 John Wiley & Sons, Inc.

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Clinical question
Do patients who take antihypertension medications have an increased risk of developing COVID-19?

Bottom line
Retrospective data from these 2 US studies show that 5 common classes of antihypertensive classes were not associated with increased risk of contracting COVID-19 or increased severity of illness. (LOE = 4)

Reference
Mehta N, Kalra A, Nowacki AS, et al. Association of use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers with testing positive for coronavirus disease 2019 (COVID-19). JAMA Cardiology. Published online May 5, 2020. doi: 10.1001/jamacardio.2020.1855. Reynolds HR, Adhikari S, Pulgarin C, et al. Renin-angiotensin-aldosterone system inhibitors and risk of Covid-19. N Engl J Med. Published online May 1, 2020; updated May 6, 2020. doi: 10.1056/NEJMoa2008975.

Study design: Other

Setting: Other

Synopsis
Research Brief #20: Researchers at the Cleveland Clinic reviewed the records of patients with suspected COVID-19 who were seen in their healthcare systems in Ohio and Florida between March 8, 2020, and April 12, 2020. They tested patients with a clinical suspicion of COVID-19 based on symptoms, travel and exposure history, and being in a high-risk group. They also tested healthcare workers based only on symptoms. Since patients prescribed angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are more likely to also have serious comorbid conditions, the researchers performed a propensity-weighted analysis to adjust for known confounders. Of the 18,472 patients tested, 1735 (9.4%) had a positive result for SARS-CoV-2. Although patients taking an ACEI had a slightly lower risk of infection with COVID-19 and patients taking an ARB had a slightly higher risk of infection, the associations were not clinically or statistically significant. However, patients taking an ACEI were more likely to be hospitalized (odds ratio [OR] 1.8; 95% CI 1.2 - 2.8) or be sent to the intensive care unit (OR 1.8; 1.07 - 2.9). Patients taking ARBs were also at a higher risk of hospitalization (OR 1.6; 1.04 - 2.5), but there was no association with going to the intensive care unit. The use of ACEIs or ARBs was also not associated with the use of mechanical ventilation. Mehta N, Kalra A, Nowacki AS, et al. Association of use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers with testing positive for coronavirus disease 2019 (COVID-19). JAMA Cardiology. Published online May 5, 2020. doi: 10.1001/jamacardio.2020.1855. Research Brief #21: These researchers, using their electronic medical record system, identified 12,594 patients tested for COVID-19 from March 1, 2020, to April 15, 2020. A total of 5894 (46.8%) tested positive for COVID-19, 1002 of whom (17.0%) had severe illness (intensive care unit admission, mechanical ventilation, or death). The high rate of positive results is reflective of highly selective test ordering, which makes comparisons with other settings challenging. Although 4357 (34.6%) of the tested patients had a history of hypertension, 2573 (59.1%) tested positive for COVID-19. Antihypertensive medication use (ACEIs, ARBs, beta-blockers, calcium-channel blockers, or thiazide diuretics) was higher in the patients with a positive test result than in those who tested negative. However, using a propensity analysis to account for known confounders, the authors found no association between any antihypertensive class and contracting COVID-19, or in the risk of severe disease among those who tested positive. Reynolds HR, Adhikari S, Pulgarin C, et al. Renin-angiotensin-aldosterone system inhibitors and risk of Covid-19. N Engl J Med. Published online May 1, 2020; updated May 6, 2020. doi: 10.1056/NEJMoa2008975.

Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI

Copyright © 2020 John Wiley & Sons, Inc.