Use of Distinct Anti-hypertensive Drugs and Risk for COVID-19 Among Hypertensive People: A Population-based Cohort Study in Southern Catalonia, Spain

Overview

Journal J Clin Hypertens (Greenwich)

Specialty Cardiology & Vascular Diseases

Date 2020 Jul 26

PMID 32710674

Citations 25

Authors

Angel Vila-Corcoles

Eva Satue-Gracia

Olga Ochoa-Gondar

Cristina Torrente-Fraga

Frederic Gomez-Bertomeu

Angel Vila-Rovira

Imma Hospital-Guardiola

Cinta de Diego-Cabanes

Ferran Bejarano-Romero

Dolors Rovira-Veciana

Josep Basora-Gallisa

Affiliations

Soon will be listed here.

Abstract

The use of some anti-hypertensive drugs in the current COVID-19 pandemic has become controversial. This study investigated possible relationships between anti-hypertensive medications use and COVID-19 infection risk in the ambulatory hypertensive population. This is a population-based retrospective cohort study involving 34 936 hypertensive adults >50 years in Tarragona (Southern Catalonia, Spain) who were retrospectively followed through pandemic period (from 01/03/2020 to 30/04/2020). Two data sets including demographic/clinical characteristics (comorbidities and cardiovascular medications use) and laboratory PCR codes for COVID-19 were linked to construct an anonymized research database. Cox regression was used to calculate multivariable hazard ratios (HRs) and estimate the risk of suffering COVID-19 infection. Across study period, 205 PCR-confirmed COVID-19 cases were observed, which means an overall incidence of 586.8 cases per 100 000 persons-period. In multivariable analyses, only age (HR: 1.03; 95% CI: 1.02-1.05; P < .001) and nursing home residence (HR: 19.60; 95% CI: 13.80-27.84; P < .001) appeared significantly associated with increased risk of COVID-19. Considering anti-hypertensive drugs, receiving diuretics (HR: 1.22; 95% CI: 0.90-1.67; P = .205), calcium channel blockers (HR: 1.29; 95%CI: 0.91-1.82; P = .148), beta-blockers (HR: 0.97; 95% CI: 0.68-1.37; P = .844), and angiotensin-converting enzyme inhibitors (HR: 0.83; 95% CI: 0.61-1.13; P = .238) did not significantly alter the risk of PCR-confirmed COVID-19, whereas receiving angiotensin II receptor blockers was associated with an almost statistically significant reduction risk (HR: 0.67; 95% CI: 0.44-1.01; P = .054). In conclusion, our data support that receiving renin-angiotensin-aldosterone system inhibitors does not predispose for suffering COVID-19 infection in ambulatory hypertensive people. Conversely, receiving angiotensin II receptor blockers could be related with a reduced risk.

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References

de Abajo F, Rodriguez-Martin S, Lerma V, Mejia-Abril G, Aguilar M, Garcia-Luque A . Use of renin-angiotensin-aldosterone system inhibitors and risk of COVID-19 requiring admission to hospital: a case-population study. Lancet. 2020; 395(10238):1705-1714. PMC: 7255214. DOI: 10.1016/S0140-6736(20)31030-8. View

Reynolds H, Adhikari S, Pulgarin C, Troxel A, Iturrate E, Johnson S . Renin-Angiotensin-Aldosterone System Inhibitors and Risk of Covid-19. N Engl J Med. 2020; 382(25):2441-2448. PMC: 7206932. DOI: 10.1056/NEJMoa2008975. View

Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A . Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020; 323(16):1574-1581. PMC: 7136855. DOI: 10.1001/jama.2020.5394. View

Kreutz R, Algharably E, Azizi M, Dobrowolski P, Guzik T, Januszewicz A . Hypertension, the renin-angiotensin system, and the risk of lower respiratory tract infections and lung injury: implications for COVID-19. Cardiovasc Res. 2020; 116(10):1688-1699. PMC: 7184480. DOI: 10.1093/cvr/cvaa097. View

Lopes R, Macedo A, de Barros E Silva P, Moll-Bernardes R, Feldman A, Arruda G . Continuing versus suspending angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: Impact on adverse outcomes in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)--The BRACE CORONA Trial. Am Heart J. 2020; 226:49-59. PMC: 7219415. DOI: 10.1016/j.ahj.2020.05.002. View

Reiner Z, Hatamipour M, Banach M, Pirro M, Al-Rasadi K, Jamialahmadi T . Statins and the COVID-19 main protease: evidence on direct interaction. Arch Med Sci. 2020; 16(3):490-496. PMC: 7212226. DOI: 10.5114/aoms.2020.94655. View

Park S, Lee H, Cho E, Sung K, Kim J, Kim D . Is the use of RAS inhibitors safe in the current era of COVID-19 pandemic?. Clin Hypertens. 2020; 26:11. PMC: 7202902. DOI: 10.1186/s40885-020-00144-0. View

Kai H, Kai M . Interactions of coronaviruses with ACE2, angiotensin II, and RAS inhibitors-lessons from available evidence and insights into COVID-19. Hypertens Res. 2020; 43(7):648-654. PMC: 7184165. DOI: 10.1038/s41440-020-0455-8. View

Versmissen J, Verdonk K, Lafeber M, van den Akker J, Hunfeld N, Hoorn E . Angiotensin-converting enzyme-2 in SARS-CoV-2 infection: good or bad?. J Hypertens. 2020; 38(6):1196-1197. PMC: 7236856. DOI: 10.1097/HJH.0000000000002472. View

10.

Lieberman J, Pepper G, Naccache S, Huang M, Jerome K, Greninger A . Comparison of Commercially Available and Laboratory-Developed Assays for Detection of SARS-CoV-2 in Clinical Laboratories. J Clin Microbiol. 2020; 58(8). PMC: 7383518. DOI: 10.1128/JCM.00821-20. View

11.

Vila-Corcoles A, Hospital-Guardiola I, Ochoa-Gondar O, de Diego C, Salsench E, Raga X . Rationale and design of the CAPAMIS study: effectiveness of pneumococcal vaccination against community-acquired pneumonia, acute myocardial infarction and stroke. BMC Public Health. 2010; 10:25. PMC: 2822825. DOI: 10.1186/1471-2458-10-25. View

12.

Deng G, Yin M, Chen X, Zeng F . Clinical determinants for fatality of 44,672 patients with COVID-19. Crit Care. 2020; 24(1):179. PMC: 7187660. DOI: 10.1186/s13054-020-02902-w. View

13.

Testa S, Prandoni P, Paoletti O, Morandini R, Tala M, Dellanoce C . Direct oral anticoagulant plasma levels' striking increase in severe COVID-19 respiratory syndrome patients treated with antiviral agents: The Cremona experience. J Thromb Haemost. 2020; 18(6):1320-1323. PMC: 7264501. DOI: 10.1111/jth.14871. View

14.

Wan Y, Shang J, Graham R, Baric R, Li F . Receptor Recognition by the Novel Coronavirus from Wuhan: an Analysis Based on Decade-Long Structural Studies of SARS Coronavirus. J Virol. 2020; 94(7). PMC: 7081895. DOI: 10.1128/JVI.00127-20. View

15.

Vila-Corcoles A, Satue-Gracia E, Ochoa-Gondar O, Torrente-Fraga C, Gomez-Bertomeu F, Vila-Rovira A . Use of distinct anti-hypertensive drugs and risk for COVID-19 among hypertensive people: A population-based cohort study in Southern Catalonia, Spain. J Clin Hypertens (Greenwich). 2020; 22(8):1379-1388. PMC: 8029672. DOI: 10.1111/jch.13948. View

16.

Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q . Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis. 2020; 94:91-95. PMC: 7194638. DOI: 10.1016/j.ijid.2020.03.017. View

17.

Mancia G, Rea F, Ludergnani M, Apolone G, Corrao G . Renin-Angiotensin-Aldosterone System Blockers and the Risk of Covid-19. N Engl J Med. 2020; 382(25):2431-2440. PMC: 7206933. DOI: 10.1056/NEJMoa2006923. View

18.

Jarcho J, Ingelfinger J, Hamel M, DAgostino Sr R, Harrington D . Inhibitors of the Renin-Angiotensin-Aldosterone System and Covid-19. N Engl J Med. 2020; 382(25):2462-2464. PMC: 7224604. DOI: 10.1056/NEJMe2012924. View

19.

Esler M, Esler D . Can angiotensin receptor-blocking drugs perhaps be harmful in the COVID-19 pandemic?. J Hypertens. 2020; 38(5):781-782. DOI: 10.1097/HJH.0000000000002450. View

20.

Zhang P, Zhu L, Cai J, Lei F, Qin J, Xie J . Association of Inpatient Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Mortality Among Patients With Hypertension Hospitalized With COVID-19. Circ Res. 2020; 126(12):1671-1681. PMC: 7265882. DOI: 10.1161/CIRCRESAHA.120.317134. View