Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar 15;21(1):262.
doi: 10.1186/s12879-021-05951-w.

Renin-angiotensin system inhibitors and susceptibility to COVID-19 in patients with hypertension: a propensity score-matched cohort study in primary care

Shamil Haroon #  1 , Anuradhaa Subramanian #  1 , Jennifer Cooper  1 , Astha Anand  1 , Krishna Gokhale  1 , Nathan Byne  2 , Samir Dhalla  3 , Dionisio Acosta-Mena  2 , Thomas Taverner  1 , Kelvin Okoth  1 , Jingya Wang  1 , Joht Singh Chandan  1 , Christopher Sainsbury  1   4 , Dawit Tefra Zemedikun  1 , G Neil Thomas  1 , Dhruv Parekh  5   6 , Tom Marshall  1 , Elizabeth Sapey  5   6   7 , Nicola J Adderley  8 , Krishnarajah Nirantharakumar  1   9   10
Affiliations
Free PMC article

Renin-angiotensin system inhibitors and susceptibility to COVID-19 in patients with hypertension: a propensity score-matched cohort study in primary care

Shamil Haroon et al. BMC Infect Dis. .
Free PMC article

Abstract

Introduction: Renin-angiotensin system (RAS) inhibitors have been postulated to influence susceptibility to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). This study investigated whether there is an association between their prescription and the incidence of COVID-19 and all-cause mortality.

Methods: We conducted a propensity-score matched cohort study comparing the incidence of COVID-19 among patients with hypertension prescribed angiotensin-converting enzyme I (ACE) inhibitors or angiotensin II type-1 receptor blockers (ARBs) to those treated with calcium channel blockers (CCBs) in a large UK-based primary care database (The Health Improvement Network). We estimated crude incidence rates for confirmed/suspected COVID-19 in each drug exposure group. We used Cox proportional hazards models to produce adjusted hazard ratios for COVID-19. We assessed all-cause mortality as a secondary outcome.

Results: The incidence rate of COVID-19 among users of ACE inhibitors and CCBs was 9.3 per 1000 person-years (83 of 18,895 users [0.44%]) and 9.5 per 1000 person-years (85 of 18,895 [0.45%]), respectively. The adjusted hazard ratio was 0.92 (95% CI 0.68 to 1.26). The incidence rate among users of ARBs was 15.8 per 1000 person-years (79 out of 10,623 users [0.74%]). The adjusted hazard ratio was 1.38 (95% CI 0.98 to 1.95). There were no significant associations between use of RAS inhibitors and all-cause mortality.

Conclusion: Use of ACE inhibitors was not associated with the risk of COVID-19 whereas use of ARBs was associated with a statistically non-significant increase compared to the use of CCBs. However, no significant associations were observed between prescription of either ACE inhibitors or ARBs and all-cause mortality.

PubMed Disclaimer

Conflict of interest statement

The authors have no competing interests to declare. ES reports receiving funding from HDR-UK (PIONEER Hub), Wellcome, MRC, British Lung Foundation and NIHR. DP reports receiving funding from NIHR and MRC.

Figures

Fig. 1
Fig. 1
Number of subjects at each stage of the study
Fig. 2
Fig. 2
Forest plot of adjusted hazard ratios for suspected or confirmed COVID-19, all-cause mortality and accidents, trauma and fractures (negative control)
Fig. 3
Fig. 3
Forest plot of hazard ratios for suspected or confirmed COVID-19 when including comorbidities that were excluded in the primary analysis
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Williamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE, et al. OpenSAFELY: factors associated with COVID-19 death in 17 million patients. Nature 2020:1–11. [cited 2020 Jul 9]; Nature Publishing Group. Available from: http://www.nature.com/articles/s41586-020-2521-4
    1. COVID-19 Map - Johns Hopkins Coronavirus Resource Center. [cited 2020 Jul 7]. Available from: https://coronavirus.jhu.edu/map.html
    1. Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020; Massachusetts Medical Society [cited 2020 Mar 28]. Available from: 10.1056/NEJMoa2002032.
    1. Zhang J, Dong X, Cao Y, Yuan Y, Yang Y, Yan Y, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy Eur J Allergy Clin Immunol 2020;75(7):1730–1741. Blackwell Publishing Ltd; [cited 2020 Jul 30]. Available from: 10.1111/all.14238 - PubMed
    1. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–1062. doi: 10.1016/S0140-6736(20)30566-3. - DOI - PMC - PubMed

MeSH terms

Substances