Renin-Angiotensin-Aldosterone-System inhibitor use in patients with COVID-19 infection and prevention of serious events: a cohort study in commercially insured patients in the US

Schneeweiss, M. C.; Leonard, S.; Weckstein, A.; Schneeweiss, S.; Rassen, J.

Objectives: There is a lack of clarity regarding the role of angiotensin receptor blockers (ARB) or angiotensin converting enzyme inhibitors (ACEi) in interfering with the SARS-COV-2 binding on human cells and the resulting change in disease severity. We sought to assess the risk of hospitalization for COVID-19 and serious complications in current users of ARB or ACEi compared to users of dihydropyridine calcium channel blockers (dhpCCB). Design: Cohort study Setting: The analysis used de-identified, patient-level data from HealthVerity, linking longitudinal data from US medical and pharmacy claims, which contain information on inpatient or outpatient diagnoses, procedures and medication dispensing. Participants: We identified patients aged 40+ and free of chronic kidney disease (CKD) who were newly diagnosed COVID-19, between March 1, 2020 and May 30, 2020, and adherent to ACEi, ARB, or dhpCCB therapy. Interventions: Current use of an ACEi, ARB, or dhpCCB. Main outcome measures: We compared the 30-day risk of hospitalization for COVID-19 and serious complications. Results: Of 24,708 patients identified, 7,571 were current users of an ARB, 8,484 of an ACEi, and 8,653 of a dhpCCB. The unadjusted 30-day risk of hospitalization for COVID-19 was 2.66% among ARB users, and 2.90% among ACEi users and 3.68% in dhpCCB users. In the PS-matched cohort, the risk of hospitalization among ARB users was 17% lower as compared to dhpCCB (RR=0.83; 0.68-1.00), and the risk among ACE users was 10% lower as compared to dhpCCB (RR=0.90; 0.76-1.07). When including patients with pre-existing CKD, the protective effect of ARB (RR= 0.74; 0.62-0.88) and ACEi (RR=0.84; 0.71-0.99) was more pronounced. Conclusions: This cohort study showed that neither ARB nor ACEi use increase the risk of severe COVID-19 disease among those infected, and instead suggests that current use of ARB may offer a protective effect. This study found no evidence to support the discontinuation of ARB/ACEi therapy.