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. 2020 Oct 27;7(11):ofaa519.
doi: 10.1093/ofid/ofaa519. eCollection 2020 Nov.

Effects of Recent Use of Renin-Angiotensin System Inhibitors on Mortality of Patients With Coronavirus Disease 2019

Seongman Bae  1 , Ju Hyeon Kim  2 , Ye-Jee Kim  3 , Joon Seo Lim  4 , Sung-Cheol Yun  3 , Young-Hak Kim  2 , Sang-Oh Lee  1 , Sung-Han Kim  1
Affiliations

Effects of Recent Use of Renin-Angiotensin System Inhibitors on Mortality of Patients With Coronavirus Disease 2019

Seongman Bae et al. Open Forum Infect Dis. .

Abstract

Background: There is growing concern about the potential harmful effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in patients with coronavirus disease 2019 (COVID-19) and cardiovascular diseases (CVDs). The aim of this study was to evaluate the association between recent exposure to ACEIs/ARBs and in-hospital mortality in patients with COVID-19.

Methods: We used data from a nationwide cohort of patients with COVID-19 from the health insurance claims data of South Korea, which were released for research purposes for public health by the Ministry of Health and Welfare of South Korea. Patients with COVID-19 were identified using the relevant diagnostic code. Propensity score matching (1:1) was carried out among patients with CVD according to the type of medication (ACEIs/ARBs vs other), and the risk of death was assessed.

Results: A total of 4936 patients with COVID-19 were analyzed, of whom 1048 (21.2%) had CVD. Of the 1048 patients with CVD, 864 (82.4%) received at least 1 antihypertensive medication before the diagnosis of COVID-19, including 359 (41.6%) who received ACEIs/ARBs and 505 (58.4%) who received drugs other than ACEIs/ARBs. Using the propensity scores for ACEI/ARB use, we matched 305 pairs of patients receiving ACEIs/ARBs and patients receiving other drugs. Recent use of ACEIs/ARBs was not significantly associated with in-hospital mortality in unadjusted analysis (odds ratio [OR], 0.62; 95% CI, 0.33-1.14) or propensity score matching analysis (OR, 1.00; 95% CI, 0.46-2.16).

Conclusions: In patients with COVID-19 and underlying CVDs, the recent use of ACEIs/ARBs was not significantly associated with in-hospital mortality. These findings do not support stopping or modifying ACEIs/ARBs in patients during the current COVID-19 pandemic.

Keywords: angiotensin II receptor blockers; angiotensin-converting enzyme 2; angiotensin-converting enzyme inhibitors; coronavirus disease 2019; severe acute respiratory syndrome coronavirus 2.

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Figures

Figure 1.
Figure 1.
Flowchart of study population and propensity score–matched cohort. Abbreviations: ACEIs/ARBs, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers; COVID-19, coronavirus disease 2019; CV, cardiovascular; CVD, cardiovascular disease.
See this image and copyright information in PMC

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