Association of Renin--Angiotensin--Aldosterone System Blocker use with
Covid-19 Hospitalization and All-cause Mortality in the UK Biobank
Abstract
Aim: The risk-benefit profile of angiotensin-converting enzyme
inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in
coronavirus disease 2019 (Covid-19) is still a matter of debate. With
growing evidence on the protective effect of this group of commonly used
antihypertensives in Covid-19, we aimed to thoroughly investigate the
association between the use of major classes of antihypertensive
medications and Covid-19 outcomes in comparison with the use of ACEIs
and ARBs. Methods: We conducted a population-based study in patients
with pre-existing hypertension in the UK Biobank. Multivariable logistic
regression analysis was performed adjusting for a wide range of
confounders. Results: The use of either beta-blockers (BBs),
calcium-channel blockers (CCBs), or diuretics was associated with a
higher risk of Covid-19 hospitalization compared to ACEI use (adjusted
OR, 1.63; 95% CI, 1.40 to 1.90) and ARB use (adjusted OR, 1.50; 95%
CI, 1.27 to 1.77). The risk of 28-day mortality among Covid-19 patients
was also increased among users of BBs, CCBs or diuretics when compared
to ACEI users (adjusted OR, 1.64; 95% CI, 1.23 to 2.19) but not when
compared to ARB users (adjusted OR, 1.18; 95% CI, 0.87 to 1.59).
However, no associations were observed when the same analysis was
conducted among hospitalized Covid-19 patients only. Conclusion: Our
results suggest protective effects of blocking of the
renin-angiotensin-aldosterone system on Covid-19 hospitalization and
mortality among patients with pharmaceutically treated hypertension,
which should be addressed by randomized controlled trials. If confirmed,
this finding could have high clinical relevance for treating
hypertension during the SARS-CoV-2 pandemic.