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COVID-19 Management

Does the Data Support Continued ACEI/ARB Use During the Pandemic?

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BACKGROUND AND PURPOSE:

  • Mehta et al. (JAMA Cardiology, 2020) assessed the association between
    • Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) use and the likelihood of testing positive for COVID-19

METHODS:

  • Retrospective cohort study
  • Setting
    • Cleveland Clinic Health System (Ohio and Florida)
  • Participants
    • All patients who tested for COVID-19 (March 8 to April 12, 2020)
  • Exposure
    • History of taking ACEIs or ARBs at the time of COVID-19 testing
  • Primary outcome
    • Results of COVID-19 testing in the entire cohort
    • Outcomes among those who tested positive
      • Hospitalizations
      • ICU admissions
      • Proportion of patients requiring mechanical ventilation

RESULTS:

  • 18,472 patients were tested for COVID-19
    • Mean age: 49 | 40% male | 69% white
    • Use of ACEI/ARBs: 12.4%
    • Positive COVID-19 test: 9.4%
  • Outcomes among positive patients
    • Hospital admission: 24.3%
    • ICU admission: 9.3%
    • Required mechanical ventilation: 6.4%
  • There was no significant association between ACEI and/or ARBs with COVID-19 test positivity
    • Propensity score–weighted odds ratio, 0.97 (95% CI, 0.81 to 1.15)

CONCLUSION:

  • There was no association between the use of ACEIs and/or ARBs and a positive COVID-19 test
    • Patients using ACE inhibitors/ARBs were not more likely to be infected with SARS-CoV-2 
  • Study supports current guidelines which do not recommend discontinuing ACEI/ARBs during the pandemic
  • Further research is required to address whether these medications affect disease severity

Learn More – Primary Sources:

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

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Related ObG Topics:

Cardiac Injury: A Feature of COVID-19
COVID-19, ACE Inhibitors and ARBs: Professional Guidance and Evidence Update
What are the Strongest Predictors of COVID-19 Hospitalization and Critical Illness?

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