Association of Renin--Angiotensin--Aldosterone System Blocker use with Covid-19 Hospitalization and All-cause Mortality in the UK Biobank

Abstract

Aim: The risk-benefit profile of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in coronavirus disease 2019 (Covid-19) is still a matter of debate. With growing evidence on the protective effect of this group of commonly used antihypertensives in Covid-19, we aimed to thoroughly investigate the association between the use of major classes of antihypertensive medications and Covid-19 outcomes in comparison with the use of ACEIs and ARBs. Methods: We conducted a population-based study in patients with pre-existing hypertension in the UK Biobank. Multivariable logistic regression analysis was performed adjusting for a wide range of confounders. Results: The use of either beta-blockers (BBs), calcium-channel blockers (CCBs), or diuretics was associated with a higher risk of Covid-19 hospitalization compared to ACEI use (adjusted OR, 1.63; 95% CI, 1.40 to 1.90) and ARB use (adjusted OR, 1.50; 95% CI, 1.27 to 1.77). The risk of 28-day mortality among Covid-19 patients was also increased among users of BBs, CCBs or diuretics when compared to ACEI users (adjusted OR, 1.64; 95% CI, 1.23 to 2.19) but not when compared to ARB users (adjusted OR, 1.18; 95% CI, 0.87 to 1.59). However, no associations were observed when the same analysis was conducted among hospitalized Covid-19 patients only. Conclusion: Our results suggest protective effects of blocking of the renin-angiotensin-aldosterone system on Covid-19 hospitalization and mortality among patients with pharmaceutically treated hypertension, which should be addressed by randomized controlled trials. If confirmed, this finding could have high clinical relevance for treating hypertension during the SARS-CoV-2 pandemic.

Coagulopathy and thromboembolic events a pathogenic mechanism of COVID‐19 associated with mortality: An updated review

“…have shown that using RAAS inhibitors in pre-existing hypertensive the COVID-19 patients are protective against mortality and hospitalization. 166 Dublin et al have shown that, these drugs did not increased risk of mortality and hospitalization. 167…”

“…For example, Safizadeh et al have shown that using RAAS inhibitors in pre‐existing hypertensive the COVID‐19 patients are protective against mortality and hospitalization. 166 Dublin et al have shown that, these drugs did not increased risk of mortality and hospitalization. 167 Loader et al have stated that the early stages of RAAS inhibitors will not increase the risk of severe outcomes in the COVID‐19 patients, 168 and research that have been conducted by Park et al in South Korea showed that taking RAAS inhibitors for the COVID‐19 patients are not harmful.…”

“…Most of the articles have mentioned that using these drugs are beneficial for the COVID‐19 patients, or at least they are neutral. For example, Safizadeh et al have shown that using RAAS inhibitors in pre‐existing hypertensive the COVID‐19 patients are protective against mortality and hospitalization 166 . Dublin et al have shown that, these drugs did not increased risk of mortality and hospitalization 167 .…”

Uso previo de antagonistas de la angiotensina II en pacientes hipertensos hospitalizados y mortalidad por COVID-19

“…la mortalidad y severidad en mayor medida que IECA . Por otro lado, un estudio no ha encontrado relación entre los usuarios de ARAII con incremento de mortalidad y(23) …”