COVID-19 research briefs: ACEIs and ARBs not associated with COVID-19 or the severity of the disease

Daily POEMs

Published: 2020-07-25 © 2020 John Wiley & Sons, Inc.

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Clinical question
Does use of angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) increase the likelihood or severity of COVID-19 infection?

Bottom line
This large and well-conducted Italian case-control study found no association between the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) and either infection or severe illness with COVID-19. Another study in the same issue of the journal used data from New York City and came to the same conclusions. (LOE = 3b)

Mancia G, Rea F, Ludergani M, Apolone G, Corrao G. Renin-angiotensin-aldosterone system blockers and the risk of COVID-19. N Engl J Med 2020;382(25):2431-2440.

Study design: Case-control

Funding source: Self-funded or unfunded

Setting: Population-based

Research brief # 42: The SARS-CoV-2 virus attaches to ACE2 receptors in the respiratory epithelium, and there has been concern that use of ACEIs or ARBs may be associated with infection or prognosis. This study was carried out in the Lombardy region of Italy, which was severely affected by COVID-19 early in the pandemic. The authors matched 6272 patients diagnosed with COVID-19 with 30,759 unaffected, randomly selected controls by age, sex, and residence. The mean age of participants in both case and control groups was 68 years. In general, cases were more likely to use an ACEI or ARB, but they were also more likely to use other anti-hypertensives. They performed a multivariate analysis of the association between ACEI or ARB use and infection, adjusting for comorbidities and other medication use, and a similar analysis of the association between ACEI or ARB use and the outcome of severe illness or death. While COVID-19 infection was more common with use of an ACEI or ARB in the unadjusted analysis, the adjusted analysis found no association (adjusted odds ratio [aOR] 1.03, 95% CI 0.90 - 1.18). There was also no significant association between severe course or death with use of ACEIs (aOR 0.91, 95% CI 0.69 - 1.21) or ARBs (aOR 0.83, i5% CI 0.63 - 1.10).

Mark H. Ebell, MD, MS
University of Georgia
Athens, GA

Copyright © 2020 John Wiley & Sons, Inc.