Premium
Angiotensin‐converting enzyme inhibitors and angiotensin II receptor blockers are not associated with severe COVID‐19 infection in a multi‐site UK acute hospital trust
Author(s) -
Bean Daniel M.,
Kraljevic Zeljko,
Searle Thomas,
Bendayan Rebecca,
Kevin O'Gallagher,
Pickles Andrew,
Folarin Amos,
Roguski Lukasz,
Noor Kawsar,
Shek Anthony,
Zakeri Rosita,
Shah Ajay M.,
Teo James T.H.,
Dobson Richard J.B.
Publication year - 2020
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.1924
Subject(s) - medicine , clinical endpoint , odds ratio , confidence interval , angiotensin converting enzyme , comorbidity , population , diabetes mellitus , angiotensin receptor blockers , clinical trial , endocrinology , blood pressure , environmental health
Aims The SARS‐CoV‐2 virus binds to the angiotensin‐converting enzyme 2 (ACE2) receptor for cell entry. It has been suggested that angiotensin‐converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB), which are commonly used in patients with hypertension or diabetes and may raise tissue ACE2 levels, could increase the risk of severe COVID‐19 infection. Methods and results We evaluated this hypothesis in a consecutive cohort of 1200 acute inpatients with COVID‐19 at two hospitals with a multi‐ethnic catchment population in London (UK). The mean age was 68 ± 17 years (57% male) and 74% of patients had at least one comorbidity. Overall, 415 patients (34.6%) reached the primary endpoint of death or transfer to a critical care unit for organ support within 21 days of symptom onset. A total of 399 patients (33.3%) were taking ACEi or ARB. Patients on ACEi/ARB were significantly older and had more comorbidities. The odds ratio for the primary endpoint in patients on ACEi and ARB, after adjustment for age, sex and co‐morbidities, was 0.63 (95% confidence interval 0.47–0.84, P < 0.01). Conclusions There was no evidence for increased severity of COVID‐19 in hospitalised patients on chronic treatment with ACEi or ARB. A trend towards a beneficial effect of ACEi/ARB requires further evaluation in larger meta‐analyses and randomised clinical trials.