Antihypertensive medications and risk of COVID-19

1. Amongst the five examined classes of antihypertensive medications (ACE Inhibitors, ARBs, beta blockers, calcium-channel blockers, and thiazide diuretics), none were associated with a substantial increase in likelihood of COVID-19.

Evidence Rating: 2 (Good)

Infection of host cells by SARS-CoV-2 is mediated via an interaction with membrane-bound angiotensin-converting enzyme (ACE) 2, and as such, it has been suggested that treatment with ACE inhibitors or angiotensin-receptor blockers (ARBs) may be associated with an increased risk of developing COVID-19. Antihypertensive medications such as calcium channel blockers, which do not interact with the renin-angiotensin-aldosterone system (RAAS), have been suggested as potential beneficial alternatives in affected patients. As hypertension affects nearly half of the adult American population, any potential interactions between antihypertensive medications and COVID-19 must be meaningfully sorted out, especially when considering ACE inhibitors are often prescribed as first line pharmacologic treatment for the condition. In this retrospective cohort study, data from a large health care network in New York City was used to determine whether antihypertensive medications were associated with any difference in risk of developing COVID-19. The study included 12,594 patients, 5894 (46.8%) who had confirmed COVID-19, of which 1002 patients had severe illness as indicated by ICU admission, mechanical ventilation requirements, or death. A total of 4357 (34.6%) patients from the dataset had hypertension, of which 2573 (59.1%) were COVID-19 positive. Using propensity-score matched analyses, an absolute difference of at least 10 percentage points in the likelihood of a positive test with at least 97.5% certainty was ruled out for ACE inhibitors, ARBs, beta-blockers, calcium-channel blockers, and thiazide diuretics. Likewise, there was no substantial difference in risk of developing severe disease among patients taking any of the antihypertensive medications. Overall, evidence from the study suggests that there are no direct adverse effects associated with ACE inhibitors, ARBs, or any of the other examined antihypertensive medications in the context of increasing risk of developing COVID-19.

Click to read the study in NEJM

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