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Research article
Nicola J Adderley
University of Birmingham
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0543-3254
License:
This work is licensed under a CC BY 4.0 License. Read Full License
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 ACE inhibitors or 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.
Conclusion
Use of ACE inhibitors was not associated with the risk of COVID-19 whereas use of ARBs was associated with a statistically non-significant increase compared to the use of CCBs. However, no significant associations were observed between prescription of either ACE inhibitors or ARBs and all-cause mortality.
Keywords
COVID-19, Renin-angiotensin system, ACE, ARBs
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CURRENT STATUS: Published
View the published article at BMC Infectious Diseases.
Version 1
Posted 01 Dec, 2020
No community comments so far
Review #3 received
Received 09 Dec, 2020
Editorial decision: Major revision
On 09 Dec, 2020
Reviewer #3 agreed
On 29 Nov, 2020
Review #2 received
Received 24 Nov, 2020
Review #1 received
Received 24 Nov, 2020
Reviewer #2 agreed
On 21 Nov, 2020
Editor assigned
On 21 Nov, 2020
Reviewers invited
Invitations sent on 21 Nov, 2020
Reviewer #1 agreed
On 21 Nov, 2020
Submission checks complete
On 21 Nov, 2020
Editor invited
On 19 Nov, 2020
First submitted
On 28 Oct, 2020
Metrics
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PDF Downloads: ...
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Subject Areas
Infectious Diseases
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A new preprint design is coming!
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See the published version of this preprint at BMC Infectious Diseases.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Nicola J Adderley
University of Birmingham
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0543-3254
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Infectious Diseases.
Version 1
Posted 01 Dec, 2020
No community comments so far
Review #3 received
Received 09 Dec, 2020
Editorial decision: Major revision
On 09 Dec, 2020
Reviewer #3 agreed
On 29 Nov, 2020
Review #2 received
Received 24 Nov, 2020
Review #1 received
Received 24 Nov, 2020
Reviewer #2 agreed
On 21 Nov, 2020
Editor assigned
On 21 Nov, 2020
Reviewers invited
Invitations sent on 21 Nov, 2020
Reviewer #1 agreed
On 21 Nov, 2020
Submission checks complete
On 21 Nov, 2020
Editor invited
On 19 Nov, 2020
First submitted
On 28 Oct, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Infectious Diseases.
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 ACE inhibitors or 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.
Conclusion
Use of ACE inhibitors was not associated with the risk of COVID-19 whereas use of ARBs was associated with a statistically non-significant increase compared to the use of CCBs. However, no significant associations were observed between prescription of either ACE inhibitors or ARBs and all-cause mortality.
Figure 1
Figure 2
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
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