Association of renin–angiotensin system blockers with COVID-19 diagnosis and prognosis in patients with hypertension: a population-based study

Soler, Maria José; Ribera, Aida; Marsal, Josep R; Mendez, Ana Belen; Andres, Mireia; Azancot, Maria Antonia; Oristrell, Gerard; Méndez-Boo, Leonardo; Cohen, Jordana; Barrabés, Jose A; Ferreira-González, Ignacio

BACKGROUND: The effect of renin-angiotensin(RAS) blockade either by angiotensin-converting enzyme inhibitors (ACEi) or angiotensin-receptor blockers (ARBs) on coronavirus disease 2019(COVID-19) susceptibility, mortality and severity is inadequately described. We examined the association between renin-angiotensin system (RAS) blockade and COVID-19 diagnosis and prognosis in a large population-based cohort of patients with hypertension. METHODS: This is a cohort study using regional health records. We identified all individuals aged 18-95 years from 87 health care reference areas of the main health provider in Catalonia(Spain), with a history of hypertension from primary care records. Data were linked to COVID-19 test results, hospital, pharmacy and mortality records from 1 March 2020 to 14 August 2020. We defined exposure to RAS blockers as the dispensation of ACEi/ARBs during the three months before COVID-19 diagnosis or 1 March 2020. Primary outcomes were: COVID-19 infection, and severe progression in hospitalized patients with COVID-19(the composite of need for invasive respiratory support or death). For both outcomes and for each exposure of interest (RAAS blockade, ACEi or ARB) we estimated associations in age-sex-area-propensity matched samples. RESULTS: From a cohort of 1,365,215 inhabitants we identified 305,972 patients with hypertension history. Recent use of ACEi/ARBs in patients with hypertension was associated with a lower 6 month-cumulative incidence of COVID-19 diagnosis (3.78% [95% CI: 3.69% - 3.86%] vs 4.53% [95% CI: 4.40% - 4.65%]; p < 0.001). In the 12,344 patients with COVID-19 infection, the use of ACEi/ARBs was not associated with a higher risk of hospitalization with need for invasive respiratory support or death (OR = 0.91 (0.71 – 1.15); p = 0.426). CONCLUSION: RAS blockade in patients with hypertension is not associated with higher risk of COVID-19 infection or with a worse progression of the disease.