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Renin-Angiotensin-Aldosterone System Inhibitors and Risk of Covid-19.
N Engl J Med. 2020 06 18; 382(25):2441-2448.NEJM

Abstract

BACKGROUND

There is concern about the potential of an increased risk related to medications that act on the renin-angiotensin-aldosterone system in patients exposed to coronavirus disease 2019 (Covid-19), because the viral receptor is angiotensin-converting enzyme 2 (ACE2).

METHODS

We assessed the relation between previous treatment with ACE inhibitors, angiotensin-receptor blockers, beta-blockers, calcium-channel blockers, or thiazide diuretics and the likelihood of a positive or negative result on Covid-19 testing as well as the likelihood of severe illness (defined as intensive care, mechanical ventilation, or death) among patients who tested positive. Using Bayesian methods, we compared outcomes in patients who had been treated with these medications and in untreated patients, overall and in those with hypertension, after propensity-score matching for receipt of each medication class. A difference of at least 10 percentage points was prespecified as a substantial difference.

RESULTS

Among 12,594 patients who were tested for Covid-19, a total of 5894 (46.8%) were positive; 1002 of these patients (17.0%) had severe illness. A history of hypertension was present in 4357 patients (34.6%), among whom 2573 (59.1%) had a positive test; 634 of these patients (24.6%) had severe illness. There was no association between any single medication class and an increased likelihood of a positive test. None of the medications examined was associated with a substantial increase in the risk of severe illness among patients who tested positive.

CONCLUSIONS

We found no substantial increase in the likelihood of a positive test for Covid-19 or in the risk of severe Covid-19 among patients who tested positive in association with five common classes of antihypertensive medications.

Authors+Show Affiliations

From the New York University (NYU) Grossman School of Medicine, New York.From the New York University (NYU) Grossman School of Medicine, New York.From the New York University (NYU) Grossman School of Medicine, New York.From the New York University (NYU) Grossman School of Medicine, New York.From the New York University (NYU) Grossman School of Medicine, New York.From the New York University (NYU) Grossman School of Medicine, New York.From the New York University (NYU) Grossman School of Medicine, New York.From the New York University (NYU) Grossman School of Medicine, New York.From the New York University (NYU) Grossman School of Medicine, New York.From the New York University (NYU) Grossman School of Medicine, New York.From the New York University (NYU) Grossman School of Medicine, New York.From the New York University (NYU) Grossman School of Medicine, New York.From the New York University (NYU) Grossman School of Medicine, New York.From the New York University (NYU) Grossman School of Medicine, New York.From the New York University (NYU) Grossman School of Medicine, New York.From the New York University (NYU) Grossman School of Medicine, New York.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

32356628

Citation

Reynolds, Harmony R., et al. "Renin-Angiotensin-Aldosterone System Inhibitors and Risk of Covid-19." The New England Journal of Medicine, vol. 382, no. 25, 2020, pp. 2441-2448.
Reynolds HR, Adhikari S, Pulgarin C, et al. Renin-Angiotensin-Aldosterone System Inhibitors and Risk of Covid-19. N Engl J Med. 2020;382(25):2441-2448.
Reynolds, H. R., Adhikari, S., Pulgarin, C., Troxel, A. B., Iturrate, E., Johnson, S. B., Hausvater, A., Newman, J. D., Berger, J. S., Bangalore, S., Katz, S. D., Fishman, G. I., Kunichoff, D., Chen, Y., Ogedegbe, G., & Hochman, J. S. (2020). Renin-Angiotensin-Aldosterone System Inhibitors and Risk of Covid-19. The New England Journal of Medicine, 382(25), 2441-2448. https://doi.org/10.1056/NEJMoa2008975
Reynolds HR, et al. Renin-Angiotensin-Aldosterone System Inhibitors and Risk of Covid-19. N Engl J Med. 2020 06 18;382(25):2441-2448. PubMed PMID: 32356628.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Renin-Angiotensin-Aldosterone System Inhibitors and Risk of Covid-19. AU - Reynolds,Harmony R, AU - Adhikari,Samrachana, AU - Pulgarin,Claudia, AU - Troxel,Andrea B, AU - Iturrate,Eduardo, AU - Johnson,Stephen B, AU - Hausvater,Anaïs, AU - Newman,Jonathan D, AU - Berger,Jeffrey S, AU - Bangalore,Sripal, AU - Katz,Stuart D, AU - Fishman,Glenn I, AU - Kunichoff,Dennis, AU - Chen,Yu, AU - Ogedegbe,Gbenga, AU - Hochman,Judith S, Y1 - 2020/05/01/ PY - 2020/5/2/pubmed PY - 2020/6/27/medline PY - 2020/5/2/entrez SP - 2441 EP - 2448 JF - The New England journal of medicine JO - N Engl J Med VL - 382 IS - 25 N2 - BACKGROUND: There is concern about the potential of an increased risk related to medications that act on the renin-angiotensin-aldosterone system in patients exposed to coronavirus disease 2019 (Covid-19), because the viral receptor is angiotensin-converting enzyme 2 (ACE2). METHODS: We assessed the relation between previous treatment with ACE inhibitors, angiotensin-receptor blockers, beta-blockers, calcium-channel blockers, or thiazide diuretics and the likelihood of a positive or negative result on Covid-19 testing as well as the likelihood of severe illness (defined as intensive care, mechanical ventilation, or death) among patients who tested positive. Using Bayesian methods, we compared outcomes in patients who had been treated with these medications and in untreated patients, overall and in those with hypertension, after propensity-score matching for receipt of each medication class. A difference of at least 10 percentage points was prespecified as a substantial difference. RESULTS: Among 12,594 patients who were tested for Covid-19, a total of 5894 (46.8%) were positive; 1002 of these patients (17.0%) had severe illness. A history of hypertension was present in 4357 patients (34.6%), among whom 2573 (59.1%) had a positive test; 634 of these patients (24.6%) had severe illness. There was no association between any single medication class and an increased likelihood of a positive test. None of the medications examined was associated with a substantial increase in the risk of severe illness among patients who tested positive. CONCLUSIONS: We found no substantial increase in the likelihood of a positive test for Covid-19 or in the risk of severe Covid-19 among patients who tested positive in association with five common classes of antihypertensive medications. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/32356628/Renin_Angiotensin_Aldosterone_System_Inhibitors_and_Risk_of_Covid_19_ DB - PRIME DP - Unbound Medicine ER -