Abstract
Background: Concerns have been raised that Angiotensin Converting Enzyme-Inhibitors (ACE-I) and Angiotensin Receptor Blockers (ARB) might facilitate transmission of SARS-CoV-2 leading to more severe coronavirus disease (COVID-19) disease and an increased risk of mortality. We aimed to investigate the association between ACE-I/ARB treatment and risk of death amongst people with COVID-19 in the first six months of the pandemic.
Methods: We identified a cohort of adults diagnosed with either confirmed or probable COVID-19 (from 1st January – 21st June 2020) using computerised medical records from the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) primary care database. This comprised 465 general practices in England, UK with a nationally representative population of 3.7 million people. We constructed mixed-effects logistic regression models to quantify the association between ACE-I/ARBs and all-cause mortality among people with COVID-19, adjusted for sociodemographic factors, co-morbidities, concurrent medication, smoking status, practice clustering and household number.
Results: There were 9,586 COVID-19 cases in the sample and 1,463 (15.3%) died during the study period between 01.01.2020 and 21.06.2020. In adjusted analysis ACE-I and ARBs were not associated with all-cause mortality (adjusted OR 1.02, 95% CI 0.85 to 1.21 and 0.84, 95% CI 0.67 to 1.07 respectively).
Conclusion: Use of ACE-I/ARB, which are commonly used drugs, did not alter the odds of all-cause mortality amongst people diagnosed with COVID-19. Our findings should inform patient and prescriber decisions concerning continued use of these medications during the pandemic.
HDM is an National Institute for Health Research funded Academic Clinical Lecturer and received NIHR SPCR funding for this project (SPCR2014-10043). SJG is supported by an MRC Epidemiology Unit programme: MC_UU_12015/4. The University of Cambridge has received salary support in respect of SJG from the NHS in the East of England through the Clinical Academic Reserve. JHC acknowledges personal support from the British Heart Foundation (FS/14/55/30806) and Cancer Research UK (C5255/A18085) through the Cancer Research UK Oxford Centre