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Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Testing Positive for Coronavirus Disease 2019 (COVID-19).
JAMA Cardiol. 2020 09 01; 5(9):1020-1026.JC

Abstract

Importance

The role of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) in the setting of the coronavirus disease 2019 (COVID-19) pandemic is hotly debated. There have been recommendations to discontinue these medications, which are essential in the treatment of several chronic disease conditions, while, in the absence of clinical evidence, professional societies have advocated their continued use.

Objective

To study the association between use of ACEIs/ARBs with the likelihood of testing positive for COVID-19 and to study outcome data in subsets of patients taking ACEIs/ARBs who tested positive with severity of clinical outcomes of COVID-19 (eg, hospitalization, intensive care unit admission, and requirement for mechanical ventilation).

Design, Setting, and Participants

Retrospective cohort study with overlap propensity score weighting was conducted at the Cleveland Clinic Health System in Ohio and Florida. All patients tested for COVID-19 between March 8 and April 12, 2020, were included.

Exposures

History of taking ACEIs or ARBs at the time of COVID-19 testing.

Main Outcomes and Measures

Results of COVID-19 testing in the entire cohort, number of patients requiring hospitalizations, intensive care unit admissions, and mechanical ventilation among those who tested positive.

Results

A total of 18 472 patients tested for COVID-19. The mean (SD) age was 49 (21) years, 7384 (40%) were male, and 12 725 (69%) were white. Of 18 472 patients who underwent COVID-19 testing, 2285 (12.4%) were taking either ACEIs or ARBs. A positive COVID-19 test result was observed in 1735 of 18 472 patients (9.4%). Among patients who tested positive, 421 (24.3%) were admitted to the hospital, 161 (9.3%) were admitted to an intensive care unit, and 111 (6.4%) required mechanical ventilation. Overlap propensity score weighting showed no significant association of ACEI and/or ARB use with COVID-19 test positivity (overlap propensity score-weighted odds ratio, 0.97; 95% CI, 0.81-1.15).

Conclusions and Relevance

This study found no association between ACEI or ARB use and COVID-19 test positivity. These clinical data support current professional society guidelines to not discontinue ACEIs or ARBs in the setting of the COVID-19 pandemic. However, further study in larger numbers of hospitalized patients receiving ACEI and ARB therapy is needed to determine the association with clinical measures of COVID-19 severity.

Authors+Show Affiliations

Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio.Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. Section of Cardiovascular Research, Heart, Vascular and Thoracic Department, Cleveland Clinic Akron General, Akron, Ohio.Lerner Research Institute, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio.Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio.Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.Pathology and Laboratory Medicine Institute, Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio.Pathology and Laboratory Medicine Institute, Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio.Lerner Research Institute, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.Heart, Vascular and Thoracic Institute, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.Cleveland Clinic, Cleveland, Ohio.Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio. Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. Lerner Research Institute, Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic, Cleveland, Ohio.

Pub Type(s)

Journal Article
Observational Study
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

32936273

Citation

Mehta, Neil, et al. "Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Testing Positive for Coronavirus Disease 2019 (COVID-19)." JAMA Cardiology, vol. 5, no. 9, 2020, pp. 1020-1026.
Mehta N, Kalra A, Nowacki AS, et al. Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Testing Positive for Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020;5(9):1020-1026.
Mehta, N., Kalra, A., Nowacki, A. S., Anjewierden, S., Han, Z., Bhat, P., Carmona-Rubio, A. E., Jacob, M., Procop, G. W., Harrington, S., Milinovich, A., Svensson, L. G., Jehi, L., Young, J. B., & Chung, M. K. (2020). Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Testing Positive for Coronavirus Disease 2019 (COVID-19). JAMA Cardiology, 5(9), 1020-1026. https://doi.org/10.1001/jamacardio.2020.1855
Mehta N, et al. Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Testing Positive for Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020 09 1;5(9):1020-1026. PubMed PMID: 32936273.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Testing Positive for Coronavirus Disease 2019 (COVID-19). AU - Mehta,Neil, AU - Kalra,Ankur, AU - Nowacki,Amy S, AU - Anjewierden,Scott, AU - Han,Zheyi, AU - Bhat,Pavan, AU - Carmona-Rubio,Andres E, AU - Jacob,Miriam, AU - Procop,Gary W, AU - Harrington,Susan, AU - Milinovich,Alex, AU - Svensson,Lars G, AU - Jehi,Lara, AU - Young,James B, AU - Chung,Mina K, PY - 2020/9/16/entrez PY - 2020/9/17/pubmed PY - 2020/10/2/medline SP - 1020 EP - 1026 JF - JAMA cardiology JO - JAMA Cardiol VL - 5 IS - 9 N2 - Importance: The role of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) in the setting of the coronavirus disease 2019 (COVID-19) pandemic is hotly debated. There have been recommendations to discontinue these medications, which are essential in the treatment of several chronic disease conditions, while, in the absence of clinical evidence, professional societies have advocated their continued use. Objective: To study the association between use of ACEIs/ARBs with the likelihood of testing positive for COVID-19 and to study outcome data in subsets of patients taking ACEIs/ARBs who tested positive with severity of clinical outcomes of COVID-19 (eg, hospitalization, intensive care unit admission, and requirement for mechanical ventilation). Design, Setting, and Participants: Retrospective cohort study with overlap propensity score weighting was conducted at the Cleveland Clinic Health System in Ohio and Florida. All patients tested for COVID-19 between March 8 and April 12, 2020, were included. Exposures: History of taking ACEIs or ARBs at the time of COVID-19 testing. Main Outcomes and Measures: Results of COVID-19 testing in the entire cohort, number of patients requiring hospitalizations, intensive care unit admissions, and mechanical ventilation among those who tested positive. Results: A total of 18 472 patients tested for COVID-19. The mean (SD) age was 49 (21) years, 7384 (40%) were male, and 12 725 (69%) were white. Of 18 472 patients who underwent COVID-19 testing, 2285 (12.4%) were taking either ACEIs or ARBs. A positive COVID-19 test result was observed in 1735 of 18 472 patients (9.4%). Among patients who tested positive, 421 (24.3%) were admitted to the hospital, 161 (9.3%) were admitted to an intensive care unit, and 111 (6.4%) required mechanical ventilation. Overlap propensity score weighting showed no significant association of ACEI and/or ARB use with COVID-19 test positivity (overlap propensity score-weighted odds ratio, 0.97; 95% CI, 0.81-1.15). Conclusions and Relevance: This study found no association between ACEI or ARB use and COVID-19 test positivity. These clinical data support current professional society guidelines to not discontinue ACEIs or ARBs in the setting of the COVID-19 pandemic. However, further study in larger numbers of hospitalized patients receiving ACEI and ARB therapy is needed to determine the association with clinical measures of COVID-19 severity. SN - 2380-6591 UR - https://www.unboundmedicine.com/medline/citation/32936273/Association_of_Use_of_Angiotensin_Converting_Enzyme_Inhibitors_and_Angiotensin_II_Receptor_Blockers_With_Testing_Positive_for_Coronavirus_Disease_2019__COVID_19__ L2 - https://jamanetwork.com/journals/jamacardiology/fullarticle/10.1001/jamacardio.2020.1855 DB - PRIME DP - Unbound Medicine ER -