Renin-Angiotensin System Inhibitors and Susceptibility to COVID-19 in Patients With Hypertension: A Propensity Score-Matched Cohort Study in Primary Care

S Haroon; A Subramanian; J Cooper; A Anand; K Gokhale; N Byne; S Dhalla; D Acosta-Mena; T Taverner; K Okoth; J Wang; JS Chandan; C Sainsbury; K Nirantharakumar

doi:10.21203/rs.3.rs-113510/v1

Renin-Angiotensin System Inhibitors and Susceptibility to COVID-19 in Patients With Hypertension: A Propensity Score-Matched Cohort Study in Primary Care

S Haroon, A Subramanian, J Cooper, A Anand, K Gokhale, N Byne, S Dhalla, D Acosta-Mena, T Taverner, K Okoth, J Wang, JS Chandan, C Sainsbury, K Nirantharakumar

Research output: Other contribution

Abstract

Introduction: Renin-angiotensin system (RAS) inhibitors have been postulated to influence susceptibility to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). This study investigated whether there is an association
between their prescription and the incidence of COVID-19 and all-cause mortality.

Methods: We conducted a propensity-score matched cohort study comparing the incidence of COVID-19 among patients with hypertension prescribed angiotensin-converting enzyme I (ACE) inhibitors or angiotensin II type-1
receptor blockers (ARBs) to those treated with calcium channel blockers (CCBs) in a large UK-based primary care database (The Health Improvement Network). We estimated crude incidence rates for confirmed/suspected COVID-19 in each drug exposure group. We used Cox proportional hazards models to produce adjusted hazard ratios for COVID-19. We assessed all-cause mortality as a secondary outcome.

Results: The incidence rate of COVID-19 among users of ACE inhibitors and CCBs was 9.3 per 1000 person-years (83 of 18,895 users [0.44%]) and 9.5 per 1000 person-years (85 of 18,895 [0.45%]), respectively. The adjusted hazard ratio was 0.92 (95% CI 0.68 to 1.26). The incidence rate among users of ARBs was 15.8 per 1000 person-years (79 out of 10,623 users [0.74%]). The adjusted hazard ratio was 1.38 (95% CI 0.98 to 1.95). There were no significant associations between use of RAS inhibitors and all-cause mortality.

Original language	English
Publisher	BMC Infectious Diseases
Edition	262
Volume	21
DOIs	https://doi.org/10.21203/rs.3.rs-113510/v1
Publication status	Published - Dec 2020

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Haroon, S., Subramanian, A., Cooper, J., Anand, A., Gokhale, K., Byne, N., Dhalla, S., Acosta-Mena, D., Taverner, T., Okoth, K., Wang, J., Chandan, JS., Sainsbury, C., & Nirantharakumar, K. (2020, Dec). Renin-Angiotensin System Inhibitors and Susceptibility to COVID-19 in Patients With Hypertension: A Propensity Score-Matched Cohort Study in Primary Care. (262 ed.) BMC Infectious Diseases. https://doi.org/10.21203/rs.3.rs-113510/v1

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title = "Renin-Angiotensin System Inhibitors and Susceptibility to COVID-19 in Patients With Hypertension: A Propensity Score-Matched Cohort Study in Primary Care",

abstract = "Introduction: Renin-angiotensin system (RAS) inhibitors have been postulated to influence susceptibility to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). This study investigated whether there is an associationbetween their prescription and the incidence of COVID-19 and all-cause mortality.Methods: We conducted a propensity-score matched cohort study comparing the incidence of COVID-19 among patients with hypertension prescribed angiotensin-converting enzyme I (ACE) inhibitors or angiotensin II type-1receptor blockers (ARBs) to those treated with calcium channel blockers (CCBs) in a large UK-based primary care database (The Health Improvement Network). We estimated crude incidence rates for confirmed/suspected COVID-19 in each drug exposure group. We used Cox proportional hazards models to produce adjusted hazard ratios for COVID-19. We assessed all-cause mortality as a secondary outcome.Results: The incidence rate of COVID-19 among users of ACE inhibitors and CCBs was 9.3 per 1000 person-years (83 of 18,895 users [0.44%]) and 9.5 per 1000 person-years (85 of 18,895 [0.45%]), respectively. The adjusted hazard ratio was 0.92 (95% CI 0.68 to 1.26). The incidence rate among users of ARBs was 15.8 per 1000 person-years (79 out of 10,623 users [0.74%]). The adjusted hazard ratio was 1.38 (95% CI 0.98 to 1.95). There were no significant associations between use of RAS inhibitors and all-cause mortality.",

author = "S Haroon and A Subramanian and J Cooper and A Anand and K Gokhale and N Byne and S Dhalla and D Acosta-Mena and T Taverner and K Okoth and J Wang and JS Chandan and C Sainsbury and K Nirantharakumar",

year = "2020",

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doi = "10.21203/rs.3.rs-113510/v1",

language = "English",

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publisher = "BMC Infectious Diseases",

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Haroon, S , Subramanian, A , Cooper, J, Anand, A, Gokhale, K, Byne, N, Dhalla, S, Acosta-Mena, D, Taverner, T, Okoth, K, Wang, J, Chandan, JS, Sainsbury, C & Nirantharakumar, K 2020, Renin-Angiotensin System Inhibitors and Susceptibility to COVID-19 in Patients With Hypertension: A Propensity Score-Matched Cohort Study in Primary Care. BMC Infectious Diseases. https://doi.org/10.21203/rs.3.rs-113510/v1

TY - GEN

T1 - Renin-Angiotensin System Inhibitors and Susceptibility to COVID-19 in Patients With Hypertension: A Propensity Score-Matched Cohort Study in Primary Care

AU - Haroon, S

AU - Subramanian, A

AU - Cooper, J

AU - Anand, A

AU - Gokhale, K

AU - Byne, N

AU - Dhalla, S

AU - Acosta-Mena, D

AU - Taverner, T

AU - Okoth, K

AU - Wang, J

AU - Chandan, JS

AU - Sainsbury, C

AU - Nirantharakumar, K

PY - 2020/12

Y1 - 2020/12

N2 - Introduction: Renin-angiotensin system (RAS) inhibitors have been postulated to influence susceptibility to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). This study investigated whether there is an associationbetween their prescription and the incidence of COVID-19 and all-cause mortality.Methods: We conducted a propensity-score matched cohort study comparing the incidence of COVID-19 among patients with hypertension prescribed angiotensin-converting enzyme I (ACE) inhibitors or angiotensin II type-1receptor blockers (ARBs) to those treated with calcium channel blockers (CCBs) in a large UK-based primary care database (The Health Improvement Network). We estimated crude incidence rates for confirmed/suspected COVID-19 in each drug exposure group. We used Cox proportional hazards models to produce adjusted hazard ratios for COVID-19. We assessed all-cause mortality as a secondary outcome.Results: The incidence rate of COVID-19 among users of ACE inhibitors and CCBs was 9.3 per 1000 person-years (83 of 18,895 users [0.44%]) and 9.5 per 1000 person-years (85 of 18,895 [0.45%]), respectively. The adjusted hazard ratio was 0.92 (95% CI 0.68 to 1.26). The incidence rate among users of ARBs was 15.8 per 1000 person-years (79 out of 10,623 users [0.74%]). The adjusted hazard ratio was 1.38 (95% CI 0.98 to 1.95). There were no significant associations between use of RAS inhibitors and all-cause mortality.

AB - Introduction: Renin-angiotensin system (RAS) inhibitors have been postulated to influence susceptibility to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). This study investigated whether there is an associationbetween their prescription and the incidence of COVID-19 and all-cause mortality.Methods: We conducted a propensity-score matched cohort study comparing the incidence of COVID-19 among patients with hypertension prescribed angiotensin-converting enzyme I (ACE) inhibitors or angiotensin II type-1receptor blockers (ARBs) to those treated with calcium channel blockers (CCBs) in a large UK-based primary care database (The Health Improvement Network). We estimated crude incidence rates for confirmed/suspected COVID-19 in each drug exposure group. We used Cox proportional hazards models to produce adjusted hazard ratios for COVID-19. We assessed all-cause mortality as a secondary outcome.Results: The incidence rate of COVID-19 among users of ACE inhibitors and CCBs was 9.3 per 1000 person-years (83 of 18,895 users [0.44%]) and 9.5 per 1000 person-years (85 of 18,895 [0.45%]), respectively. The adjusted hazard ratio was 0.92 (95% CI 0.68 to 1.26). The incidence rate among users of ARBs was 15.8 per 1000 person-years (79 out of 10,623 users [0.74%]). The adjusted hazard ratio was 1.38 (95% CI 0.98 to 1.95). There were no significant associations between use of RAS inhibitors and all-cause mortality.

UR - http://europepmc.org/abstract/PPR/PPR247024

U2 - 10.21203/rs.3.rs-113510/v1

DO - 10.21203/rs.3.rs-113510/v1

M3 - Other contribution

VL - 21

PB - BMC Infectious Diseases

ER -

Renin-Angiotensin System Inhibitors and Susceptibility to COVID-19 in Patients With Hypertension: A Propensity Score-Matched Cohort Study in Primary Care

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