Positive association of Angiotensin II Receptor Blockers, not Angiotensin-Converting Enzyme Inhibitors, with an increased vulnerability to SARS-CoV-2 infection in patients hospitalized for suspected COVID-19 pneumonia

GEORGES, J.-L.; Floriane Gilles, F.; Cochet, H.; Bertrand, A.; De Tournemire, M.; Monguillon, V.; Pasqualini, M.; Prevot, A.; Roger, G.; Saba, J.; Soltani, J.; Koukabi-Fradelizi, M.; Beressi, J. P.; Laureana, C.; Prost, J. F.; Bernard, L.

Background. Angiotensin converting enzyme (ACE) type 2 is the receptor of SARSCoV-2 for entry into lungs cells. Because ACE-2 may be modulated by ACE inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), there is concern that patients treated with ACEIs and ARBs are at higher risk for COVID-19 infection. Aim. This study sought to analyze the association of COVID-19 with previous treatment with ACEI and ARB. Methods. We retrospectively reviewed 684 consecutive patients hospitalized for suspected COVID-19 pneumonia and tested by PCR. Patients were split into 2 groups, whether (group 1, n=484) or not (group 2, n=250) COVID-19 was confirmed. Multivariate adjusted comparisons included a propensity score analysis. Results Age was 63.6 {+/-} 18.7 years, and 302(44%) were female. Hypertension was present in 42.6% and 38.4% patients of group 1 and 2, respectively (P=0.28). A treatment with ARBs (20.7% versus 12.0%, respectively, OR 1.92, 95% confidence interval [1.23-2.98], p=0.004) was more frequent in patients of group 1 than in group 2. No difference was found for treatment with ACEIs (12.7% vs 15.7%, respectively, OR 0.81 [0.52-1.26], p=0.35). Propensity score matched multivariate logistic regression confirmed a significant association between COVID-19 and a previous treatment with ARBs (adjusted OR 2.18 [1.29-3.67], p=0.004). Significant interaction between ARBs and ACEIs for the risk of COVID-19 was observed in patients aged>60, women, and hypertensive patients. Conclusion . This study suggests that ACEIs and ARBs are not similarly associated with the COVID-19. In this retrospective series, patients with COVID-19 pneumonia received more frequently a previous treatment with ARBs, than patients without COVID-19.