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Association of Angiotensin II Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors on COVID-19-Related Outcome

24 Pages Posted: 14 Apr 2020

See all articles by Hae-Young Lee

Hae-Young Lee

Korean Society of Hypertension; Seoul National University - Department of Internal Medicine

Juhee Ahn

Seoul National University - Department of Internal Medicine

Chang Kyung Kang

Seoul National University - Seoul National University Boramae Hospital

Sung-Ho Won

Seoul National University - Department of Public Health Science; Seoul National University - Institute of Health and Environment

Jong-Heon Park

National Health Insurance Service; National Health Insurance Service - Department of Benefits Strategy

Cheong Hee Kang

National Health Insurance Service

Ki-Hyun Chung

National Medical Center

Joon-Sung Joh

National Medical Center

Jiwhan Bang

National Medical Center; The Central Infectious Disease Hospital; National Committee for Clinical Management of COVID-19

Hyosoon Yoo

Government of the Republic of Korea - Korea Centers for Disease Control and Prevention (KCDC)

Ok Park

Government of the Republic of Korea - Korea Centers for Disease Control and Prevention (KCDC)

Myoung-don Oh

Seoul National University - Department of Internal Medicine; National Committee for Clinical Management of COVID-19

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Abstract

Background: Different hypotheses suggest a contradictory association of angiotensin receptor blockers (ARBs) or angiotensin-converting enzyme (ACE) inhibitors with potential adverse or favorable effects in patients infected with SARS-CoV-2. This study aimed to clarify if the use of ARB and/or ACE inhibitor should be continued in COVID-19 patients with comorbidities.

Methods: Data related to 8,266 patients with laboratory-confirmed SARS-CoV-2 infection through March 16, 2020, were retrieved. We evaluated the association of ARBs and ACE inhibitors on SARS-CoV-2-related mortality within 60 days. Furthermore, a comparison of hazard ratio (HR) was performed between SARS-CoV-2 infected patients and a retrospective cohort of patients hospitalized with pneumonia between January and June 2019 in Korea.

Findings: The median age of the patients infected by SARS-CoV-2 was 45 years, with 61.52% being female. Prevalence of hypertension was 19.04%, and ARBs and ACE inhibitors were prescribed in 11.38% and 0.44% of overall patients, respectively. As of March 24, 2020, 112 patients (1.42%) succumbed to death. The crude HR of hypertension was 4.13 (95% confidence interval [CI]. 2.48 – 6.62, p < 0.0001). However, after adjusting age, sex, and comorbidities, the association of hypertension and death was not significant (HR 1.254, 95% CI 0.734 – 2.144, P = 0.4080). Cox regression showed no increase in HR associated with ARB + ACE inhibitor groups (HR 1.067, 95% CI 0.676 – 1.650) after adjusting for age, sex, and comorbidities. SARS-CoV-2 infected patients showed a trend similar to that of the retrospective pneumonia cohort.

Interpretation: Results of the present study indicate no adverse outcome of COVID-19 in patients prescribed with ARBs or ACE inhibitors. These results support the sustained use of ARBs and ACE inhibitors in SARS-CoV-2 infection.

Funding Statement: Research Grant from the Korea Centers for Disease Control and Prevention (#4838- 330-320-01) and Seoul National University Hospital (#04-2020-0030).

Declaration of Interests: The authors declare no competing interests.

Ethics Approval Statement: The study was approved by the Institutional Review Board of Seoul National University Hospital (No. 2003- 102-1109). Informed consent was waived, both, in the light of the urgent need to collect data, and because the study was based on routinely collected administrative or claims data.

Keywords: COVID-19; Hypertension; Angiotensin receptor blocker

Suggested Citation

Lee, Hae-Young and Ahn, Juhee and Kang, Chang Kyung and Won, Sung-Ho and Park, Jong-Heon and Kang, Cheong Hee and Chung, Ki-Hyun and Joh, Joon-Sung and Bang, Jiwhan and Yoo, Hyosoon and Park, Ok and Oh, Myoung-don, Association of Angiotensin II Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors on COVID-19-Related Outcome (4/1/2020). Available at SSRN: https://ssrn.com/abstract=3569837 or http://dx.doi.org/10.2139/ssrn.3569837

Hae-Young Lee

Korean Society of Hypertension

Seoul
Korea, Democratic People's Republic (North Korea)

Seoul National University - Department of Internal Medicine

Kwanak-gu
Seoul, 151-742
Korea, Republic of (South Korea)

Juhee Ahn

Seoul National University - Department of Internal Medicine

Kwanak-gu
Seoul, 151-742
Korea, Republic of (South Korea)

Chang Kyung Kang

Seoul National University - Seoul National University Boramae Hospital

Seoul
Korea, Republic of (South Korea)

Sung-Ho Won

Seoul National University - Department of Public Health Science

1 KwanakroKwanak-gu
Seoul, 151-742
Korea, Republic of (South Korea)

Seoul National University - Institute of Health and Environment

Seoul
Korea, Republic of (South Korea)

Jong-Heon Park

National Health Insurance Service

Wonju
Korea, Republic of (South Korea)

National Health Insurance Service - Department of Benefits Strategy

Wonju
Korea, Republic of (South Korea)

Cheong Hee Kang

National Health Insurance Service

Wonju
Korea, Republic of (South Korea)

Ki-Hyun Chung

National Medical Center

Seoul
Korea, Republic of (South Korea)

Joon-Sung Joh

National Medical Center

Seoul
Korea, Republic of (South Korea)

Jiwhan Bang

National Medical Center

Seoul
Korea, Republic of (South Korea)

The Central Infectious Disease Hospital

Seoul
Korea, Republic of (South Korea)

National Committee for Clinical Management of COVID-19

Korea, Republic of (South Korea)

Hyosoon Yoo

Government of the Republic of Korea - Korea Centers for Disease Control and Prevention (KCDC)

Osong
Korea, Republic of (South Korea)

Ok Park

Government of the Republic of Korea - Korea Centers for Disease Control and Prevention (KCDC)

Osong
Korea, Republic of (South Korea)

Myoung-don Oh (Contact Author)

Seoul National University - Department of Internal Medicine ( email )

Kwanak-gu
Seoul, 151-742
Korea, Republic of (South Korea)

National Committee for Clinical Management of COVID-19 ( email )

Korea, Republic of (South Korea)

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