Treatment with ACE-inhibitors is associated with less severe disease with SARS-Covid-19 infection in a multi-site UK acute Hospital Trust

Daniel Bean; Zeljko Kraljevic; Thomas Searle; Rebecca Bendayan; Andrew Pickles; Amos Folarin; Lukasz Roguski; Kawsar Noor; Anthony Shek; Kevin o'gallagher; Rosita Zakeri; Ajay Shah; James Teo; Richard JB Dobson

The study cohort was defined as all inpatients testing positive for SARS-Cov2 by RT-PCR at King's College Hospital and Princess Royal University Hospital from 1 March to 22nd March 2020. Only patients symptomatic and requiring inpatient admission were included. The primary endpoint was defined as death or admission to a critical care unit for organ-support within 7 days of symptoms onset (symptoms defined as fever, cough, dyspnoea, myalgia, chest pain or delirium). Patients were stratified according to drug exposure to ACEi or ARB within 7 days before symptoms or during inpatient treatment (prior to an endpoint being reached). Specifically, we divided the total cohort into patients with prescription and/or mention in any text record of (1) ACEi (Ramipril, Perindopril, Lisinopril, Enalapril, Captopril, Quinapril, Imidapril, Fosinopril, Trandolapril) and (2) ARB ( Candesartan, Irbesartan, Losartan, Olmesartan, Telmisartan, Valsartan) up to 7days before or after symptom onset. We considered patients whose medication was withheld during admission as positive for drug exposure. Patients with no medication orders or clinical documents created in the study period (because never admitted) were excluded. One newborn was also excluded. The primary endpoint was manually verified by a clinician review of the electronic health record.