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Observational Study
. 2020 Sep 1;5(9):1020-1026.
doi: 10.1001/jamacardio.2020.1855.

Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Testing Positive for Coronavirus Disease 2019 (COVID-19)

Neil Mehta  1 , Ankur Kalra  2   3 , Amy S Nowacki  4 , Scott Anjewierden  1 , Zheyi Han  1 , Pavan Bhat  2 , Andres E Carmona-Rubio  2 , Miriam Jacob  2 , Gary W Procop  5 , Susan Harrington  5 , Alex Milinovich  4 , Lars G Svensson  6 , Lara Jehi  7 , James B Young  1   2 , Mina K Chung  2   8
Affiliations
Observational Study

Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Testing Positive for Coronavirus Disease 2019 (COVID-19)

Neil Mehta et al. JAMA Cardiol. .

Abstract

Importance: The role of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) in the setting of the coronavirus disease 2019 (COVID-19) pandemic is hotly debated. There have been recommendations to discontinue these medications, which are essential in the treatment of several chronic disease conditions, while, in the absence of clinical evidence, professional societies have advocated their continued use.

Objective: To study the association between use of ACEIs/ARBs with the likelihood of testing positive for COVID-19 and to study outcome data in subsets of patients taking ACEIs/ARBs who tested positive with severity of clinical outcomes of COVID-19 (eg, hospitalization, intensive care unit admission, and requirement for mechanical ventilation).

Design, setting, and participants: Retrospective cohort study with overlap propensity score weighting was conducted at the Cleveland Clinic Health System in Ohio and Florida. All patients tested for COVID-19 between March 8 and April 12, 2020, were included.

Exposures: History of taking ACEIs or ARBs at the time of COVID-19 testing.

Main outcomes and measures: Results of COVID-19 testing in the entire cohort, number of patients requiring hospitalizations, intensive care unit admissions, and mechanical ventilation among those who tested positive.

Results: A total of 18 472 patients tested for COVID-19. The mean (SD) age was 49 (21) years, 7384 (40%) were male, and 12 725 (69%) were white. Of 18 472 patients who underwent COVID-19 testing, 2285 (12.4%) were taking either ACEIs or ARBs. A positive COVID-19 test result was observed in 1735 of 18 472 patients (9.4%). Among patients who tested positive, 421 (24.3%) were admitted to the hospital, 161 (9.3%) were admitted to an intensive care unit, and 111 (6.4%) required mechanical ventilation. Overlap propensity score weighting showed no significant association of ACEI and/or ARB use with COVID-19 test positivity (overlap propensity score-weighted odds ratio, 0.97; 95% CI, 0.81-1.15).

Conclusions and relevance: This study found no association between ACEI or ARB use and COVID-19 test positivity. These clinical data support current professional society guidelines to not discontinue ACEIs or ARBs in the setting of the COVID-19 pandemic. However, further study in larger numbers of hospitalized patients receiving ACEI and ARB therapy is needed to determine the association with clinical measures of COVID-19 severity.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Milinovich reports royalties for use of REDCap from nPhase during the conduct of the study and grants from Novo Nordisk, Boehringer Ingelheim, Merck, Novartis, Otsuka, and the National Institutes of Health outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Association of ACEI and ARB With Results of SARS-CoV-2 Testing (Primary Outcome) and Secondary Clinical Outcomes: Overlap Propensity Score Weighted–Analysis ORs With 95% CIs
ACEI indicates angiotensin-converting enzyme inhibitor; ARB, angiotensin II receptor blocker; ICU, intensive care unit; OR, odds ratio; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
See this image and copyright information in PMC

Comment in

References

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