#Grand Rounds

Are ACE Inhibitors and ARBs Associated with Increased COVID-19 Susceptibility?

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BACKGROUND AND PURPOSE:

  • Hippisley-Cox et al. (Heart, 2020) used a large population study to investigate whether there is an association between ACE inhibitors and ARBs and COVID-19 disease susceptibility and progression

METHODS:

  • Prospective cohort study
  • Setting
    • General practices in England
  • Participants
    • Adults aged 20 to 99 years
  • Exposures
    • ACE inhibitors and ARB drugs
  • Study design
    • Cox proportional hazards models were used to derive adjusted hazard ratio
    • Results adjusted for confounders such as sociodemographic factors, concurrent medications and geographical region
  • Primary outcome
    • RT-PCR confirmed COVID-19
    • COVID-19 that resulted in ICU care

RESULTS:

  • 19,486 patients had COVID-19
    • Received ICU care: 1286
  • ACE inhibitors and ARBs were associated with a significantly reduced risk of COVID-19
    • ACE inhibitors
      • Adjusted HR 0.71 (95% CI, 0.67 to 0.74)
    • ARBs
      • Adjusted HR 0.63 (95% CI, 0.59 to 0.67)
  • Neither ACE inhibitors nor ARBS were associated with an increased risk of ICU care
    • ACE inhibitors
      • Adjusted HR 0.89 (95% CI, 0.75 to 1.06)
    • ARBs
      • Adjusted HR 1.02 (95% CI, 0.83 to 1.25)
  • The risk of COVID-19 disease associated with ACE inhibitors was higher in Caribbean and Black African groups vs white group | The risk of COVID-19 disease associated with ARBs was higher in the Black African group vs the white group

CONCLUSION:

  • ACE inhibitors and ARBs were associated with a reduced risk of COVID-19
  • ACE inhibitors and ARBS was not associated with an increased risk of ICU care
  • The authors state

Variations between different ethnic groups raise the possibility of ethnic-specific effects of ACE inhibitors/ARBs on COVID-19 disease susceptibility and severity which deserves further study

Learn More – Primary Sources:

Risk of severe COVID-19 disease with ACE inhibitors and angiotensin receptor blockers: cohort study including 8.3 million people

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