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Association of Renin-Angiotensin-Aldosterone Inhibitors with COVID-19 Infection and Disease Severity among Individuals with Hypertension.
Mahanaimy, Moria; Finkel, Uriah; Barda, Noam; Rottman, Eytan; Balicer, Ran; Berliner Senderey, Adi; Feldman, Becca.
  • Mahanaimy M; Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Israel.
  • Finkel U; Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Israel.
  • Barda N; Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Israel.
  • Rottman E; School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
  • Balicer R; Department of Computer, and Ben Gurion University of the Negev, Beer Sheva, Israel.
  • Berliner Senderey A; Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Israel.
  • Feldman B; Institute of Diabetes, Technology, and Research, Clalit Health Services, Israel.
Isr Med Assoc J ; 24(5): 310-316, 2022 May.
Article in English | MEDLINE | ID: covidwho-1857448
ABSTRACT

BACKGROUND:

The association between use of renin-angiotensin-aldosterone (RAAS) inhibitors and both SARS-CoV-2 infection and the development of severe COVID-19 has been presented in the recent medical literature with inconsistent results.

OBJECTIVES:

To assess the association between RAAS inhibitor use and two

outcomes:

infection with SARS-CoV-2 (Model 1) and severe COVID-19 among those infected (Model 2).

METHODS:

We accessed used electronic health records of individuals from Israel who were receiving anti-hypertensive medications for this retrospective study. For Model 1 we used a case-control design. For Model 2 we used a cohort design. In both models, inverse probability weighting adjusted for identified confounders as part of doubly robust outcome regression.

RESULTS:

We tested 38,554 individuals for SARS-CoV-2 who had hypertension and were being treated with medication; 691 had a positive test result. Among those with a positive test, 119 developed severe illness. There was no association between RAAS inhibitor use and a positive test. Use of RAAS inhibitors was associated with a decreased risk for severe COVID-19 (adjusted odds ratio [OR] 0.47, 95% confidence interval [95%CI] 0.29-0.77) compared with users of non-RAAS anti-hypertensive medication. The association remained significant when use of angiotensin-converting-enzyme inhibitors (adjusted OR 0.46, 95%CI 0.27-0.77) and angiotensin II receptor blockers (adjusted OR 0.39, 95%CI 0.16-0.95) were analyzed separately.

CONCLUSIONS:

Among individuals with hypertension using RAAS inhibitors, we found a lower risk of severe disease compared to those using non-RAAS anti-hypertensive medications. This finding suggests that RAAS inhibitors may have a protective effect on COVID-19 severity among individuals with medically treated hypertension.
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Collection: International databases Database: MEDLINE Main subject: COVID-19 Drug Treatment / Hypertension Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: Isr Med Assoc J Journal subject: Medicine Year: 2022 Document Type: Article Affiliation country: Israel

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Collection: International databases Database: MEDLINE Main subject: COVID-19 Drug Treatment / Hypertension Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: Isr Med Assoc J Journal subject: Medicine Year: 2022 Document Type: Article Affiliation country: Israel