TY - JOUR T1 - Angiotensin II receptor blocker or angiotensin-converting enzyme inhibitor use and COVID-19-related outcomes among US Veterans. AU - Derington,Catherine G, AU - Cohen,Jordana B, AU - Mohanty,April F, AU - Greene,Tom H, AU - Cook,James, AU - Ying,Jian, AU - Wei,Guo, AU - Herrick,Jennifer S, AU - Stevens,Vanessa W, AU - Jones,Barbara E, AU - Wang,Libo, AU - Zheutlin,Alexander R, AU - South,Andrew M, AU - Hanff,Thomas C, AU - Smith,Steven M, AU - Cooper-DeHoff,Rhonda M, AU - King,Jordan B, AU - Alexander,G Caleb, AU - Berlowitz,Dan R, AU - Ahmad,Faraz S, AU - Penrod,M Jason, AU - Hess,Rachel, AU - Conroy,Molly B, AU - Fang,James C, AU - Rubin,Michael A, AU - Beddhu,Srinivasan, AU - Cheung,Alfred K, AU - Xian,Weiming, AU - Weintraub,William S, AU - Bress,Adam P, Y1 - 2021/04/23/ PY - 2021/01/13/received PY - 2021/02/19/accepted PY - 2021/4/23/entrez PY - 2021/4/24/pubmed PY - 2021/5/8/medline SP - e0248080 EP - e0248080 JF - PloS one JO - PLoS One VL - 16 IS - 4 N2 - BACKGROUND: Angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) may positively or negatively impact outcomes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We investigated the association of ARB or ACEI use with coronavirus disease 2019 (COVID-19)-related outcomes in US Veterans with treated hypertension using an active comparator design, appropriate covariate adjustment, and negative control analyses. METHODS AND FINDINGS: In this retrospective cohort study of Veterans with treated hypertension in the Veterans Health Administration (01/19/2020-08/28/2020), we compared users of (A) ARB/ACEI vs. non-ARB/ACEI (excluding Veterans with compelling indications to reduce confounding by indication) and (B) ARB vs. ACEI among (1) SARS-CoV-2+ outpatients and (2) COVID-19 hospitalized inpatients. The primary outcome was all-cause hospitalization or mortality (outpatients) and all-cause mortality (inpatients). We estimated hazard ratios (HR) using propensity score-weighted Cox regression. Baseline characteristics were well-balanced between exposure groups after weighting. Among outpatients, there were 5.0 and 6.0 primary outcomes per 100 person-months for ARB/ACEI (n = 2,482) vs. non-ARB/ACEI (n = 2,487) users (HR 0.85, 95% confidence interval [CI] 0.73-0.99, median follow-up 87 days). Among outpatients who were ARB (n = 4,877) vs. ACEI (n = 8,704) users, there were 13.2 and 14.8 primary outcomes per 100 person-months (HR 0.91, 95%CI 0.86-0.97, median follow-up 85 days). Among inpatients who were ARB/ACEI (n = 210) vs. non-ARB/ACEI (n = 275) users, there were 3.4 and 2.0 all-cause deaths per 100 person months (HR 1.25, 95%CI 0.30-5.13, median follow-up 30 days). Among inpatients, ARB (n = 1,164) and ACEI (n = 2,014) users had 21.0 vs. 17.7 all-cause deaths, per 100 person-months (HR 1.13, 95%CI 0.93-1.38, median follow-up 30 days). CONCLUSIONS: This observational analysis supports continued ARB or ACEI use for patients already using these medications before SARS-CoV-2 infection. The novel beneficial association observed among outpatients between users of ARBs vs. ACEIs on hospitalization or mortality should be confirmed with randomized trials. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/33891615/Angiotensin_II_receptor_blocker_or_angiotensin_converting_enzyme_inhibitor_use_and_COVID_19_related_outcomes_among_US_Veterans_ DB - PRIME DP - Unbound Medicine ER -