Renin–Angiotensin–Aldosterone System Inhibitors and Risk of Covid-19
Top Cited Papers
Open Access
- 18 June 2020
- journal article
- research article
- Published by Massachusetts Medical Society in New England Journal of Medicine
- Vol. 382 (25), 2441-2448
- https://doi.org/10.1056/nejmoa2008975
Abstract
There is concern about the potential of an increased risk related to medications that act on the renin–angiotensin–aldosterone system in patients exposed to coronavirus disease 2019 (Covid-19), because the viral receptor is angiotensin-converting enzyme 2 (ACE2). We assessed the relation between previous treatment with ACE inhibitors, angiotensin-receptor blockers, beta-blockers, calcium-channel blockers, or thiazide diuretics and the likelihood of a positive or negative result on Covid-19 testing as well as the likelihood of severe illness (defined as intensive care, mechanical ventilation, or death) among patients who tested positive. Using Bayesian methods, we compared outcomes in patients who had been treated with these medications and in untreated patients, overall and in those with hypertension, after propensity-score matching for receipt of each medication class. A difference of at least 10 percentage points was prespecified as a substantial difference. Among 12,594 patients who were tested for Covid-19, a total of 5894 (46.8%) were positive; 1002 of these patients (17.0%) had severe illness. A history of hypertension was present in 4357 patients (34.6%), among whom 2573 (59.1%) had a positive test; 634 of these patients (24.6%) had severe illness. There was no association between any single medication class and an increased likelihood of a positive test. None of the medications examined was associated with a substantial increase in the risk of severe illness among patients who tested positive. We found no substantial increase in the likelihood of a positive test for Covid-19 or in the risk of severe Covid-19 among patients who tested positive in association with five common classes of antihypertensive medications.This publication has 19 references indexed in Scilit:
- Landiolol hydrochloride ameliorates acute lung injury in a rat model of early sepsis through the suppression of elevated levels of pulmonary endothelin-1Life Sciences, 2016
- Esmolol attenuates lung injury and inflammation in severe acute pancreatitis ratsPancreatology, 2016
- Losartan, a Selective Antagonist of AT1 Receptor, Attenuates Acute Lung Injury Induced by Seawater Inhalation in RatsChest, 2016
- Losartan, an antagonist of AT1 receptor for angiotensin II, attenuates lipopolysaccharide-induced acute lung injury in ratArchives of Biochemistry and Biophysics, 2008
- Losartan Attenuates Ventilator-Induced Lung InjuryJournal of Surgical Research, 2008
- ANGIOTENSIN-CONVERTING ENZYME INHIBITOR CAPTOPRIL PREVENTS OLEIC ACID-INDUCED SEVERE ACUTE LUNG INJURY IN RATSShock, 2007
- Effect of Angiotensin-Converting Enzyme Inhibition and Angiotensin II Receptor Blockers on Cardiac Angiotensin-Converting Enzyme 2Circulation, 2005
- Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirusNature, 2003
- β-adrenergic receptor blockade as a therapeutic approach for suppressing the renin-angiotensin-aldosterone system in normotensive and hypertensive subjectsAmerican Journal of Hypertension, 1999
- Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control groupStatistics in Medicine, 1998