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Association Between Renin-Angiotensin-Aldosterone System Inhibitors and COVID-19 Infection in South Korea.
Hypertension. 2020 09; 76(3):742-749.H

Abstract

The severe acute respiratory syndrome coronavirus 2 is known to infect host cells by interacting with ACE2 (angiotensin-converting enzyme 2) expressed in the respiratory epithelium. There have been concerns on whether alterations of ACE2 expression by renin-angiotensin-aldosterone system (RAAS) inhibitors would contribute to the infectivity and severity of coronavirus disease 2019 (COVID-19). We performed a case-control study to investigate the association between RAAS inhibitors and risk and severity of COVID-19 infection in South Korea using the population-based data provided by the Korean National Health Insurance System. Of 16 281 subjects with hypertension, there were 950 (5.8%) confirmed COVID-19 cases. After case-control matching, multivariable-adjusted conditional logistic regression analysis was performed. The adjusted odds ratio and 95% CIs for COVID-19 infection and long-term hospitalization comparing exposure to RAAS inhibitors and nonexposure to RAAS inhibitors was 1.161 (0.958-1.407) and 0.863 (0.533-1.397), respectively. When comparing exposure to RAAS inhibitors and nonexposure to RAAS inhibitors for intensive care unit admission, high-flow oxygen therapy, and death, the adjusted odds ratios (95% CIs) were 1.515 (0.402-5.701), 0.663 (0.272-1.619), and 1.363 (0.513-3.662), respectively. In all analyses, P values were not significant (P>0.05). The present study demonstrates the absence of an identifiable association between the exposure to RAAS inhibitors and risk and severity of COVID-19 infection, supporting the current medical guidelines and recommendations that patients should not discontinue RAAS inhibitors out of a concern that they are at increased risk for infection or severe illness of COVID-19.

Authors+Show Affiliations

From the Department of Biomedical Science and Engineering (M.S., S.Y.), Gwangju Institute of Science and Technology, Republic of Korea.Department of Internal Medicine, Armed Forces Goyang Hospital, Goyang-si, Republic of Korea (J.S.).From the Department of Biomedical Science and Engineering (M.S., S.Y.), Gwangju Institute of Science and Technology, Republic of Korea. School of Mechanical Engineering (S.Y.), Gwangju Institute of Science and Technology, Republic of Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32654557

Citation

Son, Minkook, et al. "Association Between Renin-Angiotensin-Aldosterone System Inhibitors and COVID-19 Infection in South Korea." Hypertension (Dallas, Tex. : 1979), vol. 76, no. 3, 2020, pp. 742-749.
Son M, Seo J, Yang S. Association Between Renin-Angiotensin-Aldosterone System Inhibitors and COVID-19 Infection in South Korea. Hypertension. 2020;76(3):742-749.
Son, M., Seo, J., & Yang, S. (2020). Association Between Renin-Angiotensin-Aldosterone System Inhibitors and COVID-19 Infection in South Korea. Hypertension (Dallas, Tex. : 1979), 76(3), 742-749. https://doi.org/10.1161/HYPERTENSIONAHA.120.15464
Son M, Seo J, Yang S. Association Between Renin-Angiotensin-Aldosterone System Inhibitors and COVID-19 Infection in South Korea. Hypertension. 2020;76(3):742-749. PubMed PMID: 32654557.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association Between Renin-Angiotensin-Aldosterone System Inhibitors and COVID-19 Infection in South Korea. AU - Son,Minkook, AU - Seo,Jeongkuk, AU - Yang,Sung, Y1 - 2020/07/13/ PY - 2020/7/14/pubmed PY - 2020/8/26/medline PY - 2020/7/14/entrez KW - COVID-19 KW - Republic of Korea KW - antihypertensive agents KW - hypertension KW - renin-angiotensin system SP - 742 EP - 749 JF - Hypertension (Dallas, Tex. : 1979) JO - Hypertension VL - 76 IS - 3 N2 - The severe acute respiratory syndrome coronavirus 2 is known to infect host cells by interacting with ACE2 (angiotensin-converting enzyme 2) expressed in the respiratory epithelium. There have been concerns on whether alterations of ACE2 expression by renin-angiotensin-aldosterone system (RAAS) inhibitors would contribute to the infectivity and severity of coronavirus disease 2019 (COVID-19). We performed a case-control study to investigate the association between RAAS inhibitors and risk and severity of COVID-19 infection in South Korea using the population-based data provided by the Korean National Health Insurance System. Of 16 281 subjects with hypertension, there were 950 (5.8%) confirmed COVID-19 cases. After case-control matching, multivariable-adjusted conditional logistic regression analysis was performed. The adjusted odds ratio and 95% CIs for COVID-19 infection and long-term hospitalization comparing exposure to RAAS inhibitors and nonexposure to RAAS inhibitors was 1.161 (0.958-1.407) and 0.863 (0.533-1.397), respectively. When comparing exposure to RAAS inhibitors and nonexposure to RAAS inhibitors for intensive care unit admission, high-flow oxygen therapy, and death, the adjusted odds ratios (95% CIs) were 1.515 (0.402-5.701), 0.663 (0.272-1.619), and 1.363 (0.513-3.662), respectively. In all analyses, P values were not significant (P>0.05). The present study demonstrates the absence of an identifiable association between the exposure to RAAS inhibitors and risk and severity of COVID-19 infection, supporting the current medical guidelines and recommendations that patients should not discontinue RAAS inhibitors out of a concern that they are at increased risk for infection or severe illness of COVID-19. SN - 1524-4563 UR - https://www.unboundmedicine.com/medline/citation/32654557/Association_Between_Renin_Angiotensin_Aldosterone_System_Inhibitors_and_COVID_19_Infection_in_South_Korea_ L2 - https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.120.15464?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -