Antihypertensive medications and COVID‐19 diagnosis and mortality: Population‐based case‐control analysis in the United Kingdom

Rezel‐Potts, Emma; Douiri, Abdel; Chowienczyk, Phil J.; Gulliford, Martin C.

AIMS: Antihypertensive drugs have been implicated in coronavirus disease 2019 (COVID‐19) susceptibility and severity, but estimated associations may be susceptible to bias. We aimed to evaluate antihypertensive medications and COVID‐19 diagnosis and mortality, accounting for healthcare‐seeking behaviour. METHODS: A population‐based case‐control study was conducted including 16 866 COVID‐19 cases and 70 137 matched controls from the UK Clinical Practice Research Datalink. We evaluated all‐cause mortality among COVID‐19 cases. Exposures were angiotensin‐converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), beta‐blockers (B), calcium‐channel blockers (C), thiazide diuretics (D) and other antihypertensive drugs (O). Analyses were adjusted for covariates and consultation frequency. RESULTS: ACEIs were associated with lower odds of COVID‐19 diagnosis (adjusted odds ratio [AOR] 0.82, 95% confidence interval [CI] 0.77‐0.88) as were ARBs (AOR 0.87, 95% CI 0.80‐0.95) with little attenuation from adjustment for consultation frequency. C and D were also associated with lower odds of COVID‐19 diagnosis. Increased odds of COVID‐19 for B (AOR 1.19, 95% CI 1.12‐1.26) were attenuated after adjustment for consultation frequency (AOR 1.01, 95% CI 0.95‐1.08). Patients treated with ACEIs or ARBs had similar odds of mortality (AOR 1.00, 95% CI 0.83‐1.20) to patients treated with classes B, C, D or O or patients receiving no antihypertensive therapy (AOR 0.99, 95% CI 0.83‐1.18). CONCLUSIONS: There was no evidence that antihypertensive therapy is associated with increased risk of COVID‐19 diagnosis or mortality; most classes of antihypertensive therapy showed negative associations with COVID‐19 diagnosis.