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Compliance of Antihypertensive Medication and Risk of Coronavirus Disease 2019: a Cohort Study Using Big Data from the Korean National Health Insurance Service.
J Korean Med Sci. 2020 Jun 29; 35(25):e232.JK

Abstract

BACKGROUND

There is a controversy whether it is safe to continue renin-angiotensin system blockers in patients with coronavirus disease 2019 (COVID-19). We analyzed big data to investigate whether angiotensin-converting enzyme inhibitors and/or angiotensin II receptor blockers have any significant effect on the risk of COVID-19. Population-based cohort study was conducted based on the prescription data from nationwide health insurance records.

METHODS

We investigated the 1,374,381 residents aged ≥ 40 years living in Daegu, the epicenter of the COVID-19 outbreak, between February and March 2020. Prescriptions of antihypertensive medication during the year before the outbreak were extracted from the National Health Insurance Service registry. Medications were categorized by types and stratified by the medication possession ratios (MPRs) of antihypertensive medications after controlling for the potential confounders. The risk of COVID-19 was estimated using a difference in difference analysis.

RESULTS

Females, older individuals, low-income earners, and recently hospitalized patients had a higher risk of infection. Patients with higher MPRs of antihypertensive medications had a consistently lower risk of COVID-19 than those with lower MPRs of antihypertensive medications and non-users. Among patients who showed complete compliance, there was a significantly lower risk of COVID-19 for those prescribed angiotensin II receptor blockers (relative risk [RR], 0.751; 95% confidence interval [CI], 0.587-0.960) or calcium channel blockers (RR, 0.768; 95% CI, 0.601-0.980).

CONCLUSION

Renin-angiotensin system blockers or other antihypertensive medications do not increase the risk of COVID-19. Patients should not stop antihypertensive medications, including renin-angiotensin system blockers, because of concerns of COVID-19.

Authors+Show Affiliations

Institute of Artificial Intelligence and Big Data in Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.Big Data Department, National Health Insurance Service, Wonju, Korea.Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. kikim907@snubh.org.Division of Infectious Diseases, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea.Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, Korea.Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea.Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea.hkcheong@skku.edu.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32597045

Citation

Kim, Jaiyong, et al. "Compliance of Antihypertensive Medication and Risk of Coronavirus Disease 2019: a Cohort Study Using Big Data From the Korean National Health Insurance Service." Journal of Korean Medical Science, vol. 35, no. 25, 2020, pp. e232.
Kim J, Kim DW, Kim KI, et al. Compliance of Antihypertensive Medication and Risk of Coronavirus Disease 2019: a Cohort Study Using Big Data from the Korean National Health Insurance Service. J Korean Med Sci. 2020;35(25):e232.
Kim, J., Kim, D. W., Kim, K. I., Kim, H. B., Kim, J. H., Lee, Y. G., Byeon, K. H., & Cheong, H. K. (2020). Compliance of Antihypertensive Medication and Risk of Coronavirus Disease 2019: a Cohort Study Using Big Data from the Korean National Health Insurance Service. Journal of Korean Medical Science, 35(25), e232. https://doi.org/10.3346/jkms.2020.35.e232
Kim J, et al. Compliance of Antihypertensive Medication and Risk of Coronavirus Disease 2019: a Cohort Study Using Big Data From the Korean National Health Insurance Service. J Korean Med Sci. 2020 Jun 29;35(25):e232. PubMed PMID: 32597045.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Compliance of Antihypertensive Medication and Risk of Coronavirus Disease 2019: a Cohort Study Using Big Data from the Korean National Health Insurance Service. AU - Kim,Jaiyong, AU - Kim,Dong Wook, AU - Kim,Kwang Il, AU - Kim,Hong Bin, AU - Kim,Jong Hun, AU - Lee,Yong Gab, AU - Byeon,Kyeong Hyang, AU - Cheong,Hae Kwan, AU - ,, Y1 - 2020/06/29/ PY - 2020/05/26/received PY - 2020/06/16/accepted PY - 2020/6/30/entrez PY - 2020/7/1/pubmed PY - 2020/7/7/medline KW - Antihypertensive Medication KW - Big Data KW - Cohort Study KW - Coronavirus Disease 2019 KW - Risk Assessment SP - e232 EP - e232 JF - Journal of Korean medical science JO - J Korean Med Sci VL - 35 IS - 25 N2 - BACKGROUND: There is a controversy whether it is safe to continue renin-angiotensin system blockers in patients with coronavirus disease 2019 (COVID-19). We analyzed big data to investigate whether angiotensin-converting enzyme inhibitors and/or angiotensin II receptor blockers have any significant effect on the risk of COVID-19. Population-based cohort study was conducted based on the prescription data from nationwide health insurance records. METHODS: We investigated the 1,374,381 residents aged ≥ 40 years living in Daegu, the epicenter of the COVID-19 outbreak, between February and March 2020. Prescriptions of antihypertensive medication during the year before the outbreak were extracted from the National Health Insurance Service registry. Medications were categorized by types and stratified by the medication possession ratios (MPRs) of antihypertensive medications after controlling for the potential confounders. The risk of COVID-19 was estimated using a difference in difference analysis. RESULTS: Females, older individuals, low-income earners, and recently hospitalized patients had a higher risk of infection. Patients with higher MPRs of antihypertensive medications had a consistently lower risk of COVID-19 than those with lower MPRs of antihypertensive medications and non-users. Among patients who showed complete compliance, there was a significantly lower risk of COVID-19 for those prescribed angiotensin II receptor blockers (relative risk [RR], 0.751; 95% confidence interval [CI], 0.587-0.960) or calcium channel blockers (RR, 0.768; 95% CI, 0.601-0.980). CONCLUSION: Renin-angiotensin system blockers or other antihypertensive medications do not increase the risk of COVID-19. Patients should not stop antihypertensive medications, including renin-angiotensin system blockers, because of concerns of COVID-19. SN - 1598-6357 UR - https://www.unboundmedicine.com/medline/citation/32597045/Compliance_of_Antihypertensive_Medication_and_Risk_of_Coronavirus_Disease_2019:_a_Cohort_Study_Using_Big_Data_from_the_Korean_National_Health_Insurance_Service_ L2 - https://jkms.org/DOIx.php?id=10.3346/jkms.2020.35.e232 DB - PRIME DP - Unbound Medicine ER -