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

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).

2020-05-01

Reynolds, Harmony R., Samrachana Adhikari, Claudia Pulgarin, Andrea B. Troxel, Eduardo Iturrate, Stephen B. Johnson, Anaïs Hausvater, Jonathan D. Newman, Jeffrey S. Berger, Sripal Bangalore, Stuart D. Katz, Glenn I. Fishman, Dennis Kunichoff, Yu Chen, Gbenga Ogedegbe, and Judith S. Hochman. 2020. "Renin–Angiotensin–Aldosterone System Inhibitors and Risk of Covid-19." New England Journal of Medicine.

Background

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).

Methods

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.

Results

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.

Conclusions

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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