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Risk of Covid-19-Related Hospitalization and More Severe Outcomes in Medicare Beneficiaries Treated with Renin-Angiotensin-Aldosterone System Inhibitors for Hypertension.
Graham, David J; Izurieta, Hector S; Muthuri, Stella G; Zhang, Di; Sandhu, Alexander T; Lu, Yun; Zhao, Yueqin; Feng, Yuhui; Eworuke, Efe; Lyu, Hai; Gandotra, Charu; Smith, Elizabeth R; Avagyan, Armen; Wernecke, Michael; Kelman, Jeffrey A; Forshee, Richard A; MaCurdy, Thomas E.
  • Graham DJ; Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, 10903 New Hampshire Ave, Building 22, Room 4314, Silver Spring, MD, 20993, USA. david.graham1@fda.hhs.gov.
  • Izurieta HS; Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.
  • Muthuri SG; Acumen LLC, Burlingame, CA, USA.
  • Zhang D; Office of Biostatistics, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.
  • Sandhu AT; Acumen LLC, Burlingame, CA, USA.
  • Lu Y; Division of Cardiology, Department of Medicine, Stanford University, Stanford, CA, USA.
  • Zhao Y; Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.
  • Feng Y; Office of Biostatistics, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.
  • Eworuke E; Acumen LLC, Burlingame, CA, USA.
  • Lyu H; Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, 10903 New Hampshire Ave, Building 22, Room 4314, Silver Spring, MD, 20993, USA.
  • Gandotra C; Acumen LLC, Burlingame, CA, USA.
  • Smith ER; Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.
  • Avagyan A; Acumen LLC, Burlingame, CA, USA.
  • Wernecke M; Acumen LLC, Burlingame, CA, USA.
  • Kelman JA; Acumen LLC, Burlingame, CA, USA.
  • Forshee RA; Centers for Medicare & Medicaid Services, Washington, DC, USA.
  • MaCurdy TE; Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.
J Gen Intern Med ; 36(12): 3802-3809, 2021 12.
Article in English | MEDLINE | ID: covidwho-1446213
ABSTRACT

BACKGROUND:

There are theoretical concerns that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) could increase the risk of severe Covid-19.

OBJECTIVE:

To determine if ACEIs and ARBs are associated with an increased risk of Covid-19 hospitalization overall, or hospitalization involving intensive care unit (ICU) admission, invasive mechanical ventilation, or death.

DESIGN:

Observational case-control study.

PARTICIPANTS:

Medicare beneficiaries aged ≥ 66 years with hypertension, treated with ACEIs, ARBs, calcium channel blockers (CCBs), or thiazide diuretics. MAIN

MEASURES:

Adjusted odds ratios (OR) and 95% confidence intervals (CI) for the outcomes of Covid-19 hospitalization, or hospitalization involving ICU admission, invasive mechanical ventilation, or death.

RESULTS:

A total of 35,300 cases of hospitalized Covid-19 were matched to 228,228 controls on calendar date and neighborhood of residence. The median age of cases was 79 years, 57.4% were female, and the median duration of hospitalization was 8 days (interquartile range 5-12). ACEIs and ARBs were associated with a slight reduction in Covid-19 hospitalization risk compared with treatment with other first-line antihypertensives (OR for ACEIs 0.95, 95% CI 0.92-0.98; OR for ARBs 0.94, 95% CI 0.90-0.97). Similar results were obtained for hospitalizations involving ICU admission, invasive mechanical ventilation, or death. There were no meaningful differences in risk for ACEIs compared with ARBs. In an analysis restricted to monotherapy with a first-line agent, CCBs were associated with a small increased risk of Covid-19 hospitalization compared with ACEIs (OR 1.09, 95% CI 1.04-1.14), ARBs (OR 1.10, 95% CI 1.05-1.15), or thiazide diuretics (OR 1.11, 95% CI 1.03-1.19).

CONCLUSIONS:

ACEIs and ARBs were not associated with an increased risk of Covid-19 hospitalization or with hospitalization involving ICU admission, invasive mechanical ventilation, or death. The finding of a small increased risk of Covid-19 hospitalization with CCBs was unexpected and could be due to residual confounding.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Hypertension Type of study: Etiology study / Observational study / Risk factors Limits: Aged / Female / Humans Country/Region as subject: North America Language: English Journal: J Gen Intern Med Journal subject: Internal Medicine Year: 2021 Document Type: Article Affiliation country: S11606-021-07155-z

Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Hypertension Type of study: Etiology study / Observational study / Risk factors Limits: Aged / Female / Humans Country/Region as subject: North America Language: English Journal: J Gen Intern Med Journal subject: Internal Medicine Year: 2021 Document Type: Article Affiliation country: S11606-021-07155-z