Renin–Angiotensin–Aldosterone System Inhibitors and Risk of Covid-19

Jun 12 2020 , India

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There is concern about the potential of an increased risk related to medications
that act on the renin–angiotensin–aldosterone system in patients exposed to coronavirus
disease 2019 (Covid-19), because the viral receptor is angiotensin-converting
enzyme 2 (ACE2).
We assessed the relation between previous treatment with ACE inhibitors, angiotensin-
receptor blockers, beta-blockers, calcium-channel blockers, or thiazide diuretics
and the likelihood of a positive or negative result on Covid-19 testing as
well as the likelihood of severe illness (defined as intensive care, mechanical
ventilation, or death) among patients who tested positive. Using Bayesian methods,
we compared outcomes in patients who had been treated with these medications
and in untreated patients, overall and in those with hypertension, after
propensity-score matching for receipt of each medication class. A difference of at
least 10 percentage points was prespecified as a substantial difference.
Among 12,594 patients who were tested for Covid-19, a total of 5894 (46.8%) were
positive; 1002 of these patients (17.0%) had severe illness. A history of hypertension
was present in 4357 patients (34.6%), among whom 2573 (59.1%) had a positive
test; 634 of these patients (24.6%) had severe illness. There was no association
between any single medication class and an increased likelihood of a positive test.
None of the medications examined was associated with a substantial increase in
the risk of severe illness among patients who tested positive.
We found no substantial increase in the likelihood of a positive test for Covid-19
or in the risk of severe Covid-19 among patients who tested positive in association
with five common classes of antihypertensive medications.

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