Association of Angiotensin II Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors on COVID-19-Related Outcome

Background: Different hypotheses suggest a contradictory association of angiotensin receptor blockers (ARBs) or angiotensin-converting enzyme (ACE) inhibitors with potential adverse or favorable effects in patients infected with SARS-CoV-2. This study aimed to clarify if the use of ARB and/or ACE inhibitor should be continued in COVID-19 patients with comorbidities. Methods: Data related to 8,266 patients with laboratory-confirmed SARS-CoV-2 infection through March 16, 2020, were retrieved. We evaluated the association of ARBs and ACE inhibitors on SARS-CoV-2-related mortality within 60 days. Furthermore, a comparison of hazard ratio (HR) was performed between SARS-CoV-2 infected patients and a retrospective cohort of patients hospitalized with pneumonia between January and June 2019 in Korea. Findings: The median age of the patients infected by SARS-CoV-2 was 45 years, with 61.52% being female. Prevalence of hypertension was 19.04%, and ARBs and ACE inhibitors were prescribed in 11.38% and 0.44% of overall patients, respectively. As of March 24, 2020, 112 patients (1.42%) succumbed to death. The crude HR of hypertension was 4.13 (95% confidence interval [CI]. 2.48 – 6.62, p < 0.0001). However, after adjusting age, sex, and comorbidities, the association of hypertension and death was not significant (HR 1.254, 95% CI 0.734 – 2.144, P = 0.4080). Cox regression showed no increase in HR associated with ARB + ACE inhibitor groups (HR 1.067, 95% CI 0.676 – 1.650) after adjusting for age, sex, and comorbidities. SARS-CoV-2 infected patients showed a trend similar to that of the retrospective pneumonia cohort. Interpretation: Results of the present study indicate no adverse outcome of COVID-19 in patients prescribed with ARBs or ACE inhibitors. These results support the sustained use of ARBs and ACE inhibitors in SARS-CoV-2 infection. Funding Statement: Research Grant from the Korea Centers for Disease Control and Prevention (#4838- 330-320-01) and Seoul National University Hospital (#04-2020-0030). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study was approved by the Institutional Review Board of Seoul National University Hospital (No. 2003- 102-1109). Informed consent was waived, both, in the light of the urgent need to collect data, and because the study was based on routinely collected administrative or claims data.