Affiliation:
1. Research & Evaluation Kaiser Permanente Southern California Pasadena CA
2. Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena CA
3. Southern California Permanente Medical Group Pasadena CA
Abstract
Background
Previous reports suggest that the use of angiotensin‐converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) may upregulate angiotensin‐converting enzyme 2 receptors and increase severe acute respiratory syndrome coronavirus 2 infectivity. We evaluated the association between ACEI or ARB use and coronavirus disease 2019 (COVID‐19) infection among patients with hypertension.
Methods and Results
We identified patients with hypertension as of March 1, 2020 (index date) from Kaiser Permanente Southern California. Patients who received ACEIs, ARBs, calcium channel blockers, beta blockers, thiazide diuretics (TD), or no therapy were identified using outpatient pharmacy data covering the index date. Outcome of interest was a positive reverse transcription polymerase chain reaction test for COVID‐19 between March 1 and May 6, 2020. Patient sociodemographic and clinical characteristics were identified within 1 year preindex date. Among 824 650 patients with hypertension, 16 898 (2.0%) were tested for COVID‐19. Of those tested, 1794 (10.6%) had a positive result. Overall, exposure to ACEIs or ARBs was not statistically significantly associated with COVID‐19 infection after propensity score adjustment (odds ratio [OR], 1.06; 95% CI, 0.90–1.25) for ACEIs versus calcium channel blockers/beta blockers/TD; OR, 1.10; 95% CI, 0.91–1.31 for ARBs versus calcium channel blockers/beta blockers/TD). The associations between ACEI use and COVID‐19 infection varied in different age groups (
P
‐interaction=0.03). ACEI use was associated with lower odds of COVID‐19 among those aged ≥85 years (OR, 0.30; 95% CI, 0.12–0.77). Use of no antihypertensive medication was significantly associated with increased odds of COVID‐19 infection compared with calcium channel blockers/beta blockers/TD (OR, 1.32; 95% CI, 1.11–1.56).
Conclusions
Neither ACEI nor ARB use was associated with increased likelihood of COVID‐19 infection. Decreased odds of COVID‐19 infection among adults ≥85 years using ACEIs warrants further investigation.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
26 articles.
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