SARS-CoV-2 infection and adverse outcomes in users of ACE inhibitors and angiotensin-receptor blockers: a nationwide case-control and cohort analysis.
OBJECTIVE
To examine the impact of ACE inhibitor (ACE-I)/angiotensin receptor blocker (ARB) use on rate of SARS-CoV-2 infection and adverse outcomes.


METHODS
This nationwide case-control and cohort study included all individuals in Denmark tested for SARS-CoV-2 RNA with PCR from 27 February 2020 to 26 July 2020. We estimated confounder-adjusted ORs for a positive test among all SARS-CoV-2 tested, and inverse probability of treatment weighted 30-day risk and risk ratios (RRs) of hospitalisation, intensive care unit (ICU) admission and mortality comparing current ACE-I/ARB use with calcium channel blocker (CCB) use and with non-use.


RESULTS
The study included 13 501 SARS-CoV-2 PCR-positive and 1 088 695 PCR-negative individuals. Users of ACE-I/ARB had a marginally increased rate of a positive PCR when compared with CCB users (aOR 1.17, 95% CI 1.00 to 1.37), but not when compared with non-users (aOR 1.00 95% CI 0.92 to 1.09).Among PCR-positive individuals, 1466 (11%) were ACE-I/ARB users. The weighted risk of hospitalisation was 36.5% in ACE-I/ARB users and 43.3% in CCB users (RR 0.84, 95% CI 0.70 to 1.02). The risk of ICU admission was 6.3% in ACE-I/ARB users and 5.4% in CCB users (RR 1.17, 95% CI 0.64 to 2.16), while the 30-day mortality was 12.3% in ACE-I/ARB users and 13.9% in CCB users (RR 0.89, 95% CI 0.61 to 1.30). The associations were similar when ACE-I/ARB users were compared with non-users.


CONCLUSIONS
ACE-I/ARB use was associated neither with a consistently increased rate nor with adverse outcomes of SARS-CoV-2 infection. Our findings support the current recommendation of continuing use of ACE-Is/ARBs during the SARS-CoV-2 pandemic.


TRIAL REGISTRATION NUMBER
EUPAS34887.
['Christiansen|Christian Fynbo|CF|0000-0002-0727-953X', 'Pottegård|Anton|A|', 'Heide-Jørgensen|Uffe|U|', 'Bodilsen|Jacob|J|0000-0002-7398-814X', 'Søgaard|Ole Schmeltz|OS|', 'Maeng|Michael|M|', 'Vistisen|Simon Tilma|ST|', 'Schmidt|Morten|M|', 'Lund|Lars Christian|LC|', 'Reilev|Mette|M|0000-0003-1241-4385', 'Hallas|Jesper|J|', 'Voldstedlund|Marianne|M|', 'Husby|Anders|A|', 'Thomsen|Marianne Kragh|MK|', 'Johansen|Nanna Borup|NB|', 'Brun|Nikolai Constantin|NC|', 'Thomsen|Reimar Wernich|RW|0000-0001-9135-3474', 'Bøtker|Hans Erik|HE|', 'Sørensen|Henrik Toft|HT|']
D000328:Adult D057911:Angiotensin Receptor Antagonists D000806:Angiotensin-Converting Enzyme Inhibitors D000086382:COVID-19 D016022:Case-Control Studies D003718:Denmark D005260:Female D006801:Humans D007362:Intensive Care Units D008297:Male D008875:Middle Aged D058873:Pandemics D011159:Population Surveillance D000086402:SARS-CoV-2
clinical epidemiology critical care respiratory infection viral infection