scholarly journals Severity of COVID-19 Infection in ACEI/ARB Users in Two Saudi Public Specialty Hospitals; Retrospective Cohort Study

2020 ◽  
Author(s):  
Ahmed A. Alrashed ◽  
Tahir M. Khan ◽  
Noara K. Alhusseini ◽  
Syed Mohammed Basheeruddin Asdaq ◽  
Mushira Enani ◽  
...  
Keyword(s):  
Cohort Study ◽  
Renal Disease ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme Inhibitors ◽  
Specialty Hospitals ◽  
Patients With Diabetes

Abstract The uncertainty about COVID-19 outcomes in angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) users continues with contradictory findings. The aim of this study was to determine the effect of ACEI/ARB use in patients with severe COVID-19. This retrospective cohort study done in two Saudi public specialty hospitals designated as COVID-19 referral facilities. We included 354 patients with confirmed diagnosis of COVID-19 between April and June 2020, of which 146 were ACEI/ARB users and 208 were non-ACEI/ARB users. Controlling for confounders, we conducted a multivariate logistic regression and a sensitivity analysis using propensity score matched (PSM) patients. Compared to non-ACEI/ARB users, ACEI/ARB users had an eight-fold higher risk of developing critical or severe COVID-19 (OR=8.25, 95%CI=3.32-20.53); a nearly 7-fold higher risk of intensive care unit (ICU) admission (OR=6.76, 95%CI=2.88-15.89) and a nearly 5-fold higher risk of requiring noninvasive ventilation (OR=4.77,95%CI=2.15-10.55). Patients with diabetes, hypertension, and/or renal disease had a five-fold higher risk of severe COVID-19 disease (OR=5.40,95%CI=2.0-14.54]. These results were confirmed in the PSM analysis. In general, but especially among patients with hypertension, diabetes, and/or renal disease, ACEI/ARB use is associated with a significantly higher risk of severe or critical COVID-19 disease, and ICU care.

scholarly journals Severity of COVID-19 Infection in ACEI/ARB Users in Two Saudi Public Specialty Hospitals: Retrospective Cohort Study

2020 ◽  
Author(s):  
Ahmed A. Alrashed ◽  
Tahir Khan ◽  
Noara Alhusseini ◽  
Syed Mohammed Asdaq ◽  
Mushira Enani ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Renal Disease ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Angiotensin Receptor Blockers ◽  
High Risk Patient ◽  
Sensitivity Analyses ◽  
Converting Enzyme Inhibitors ◽  
Specialty Hospitals

Abstract Background: The uncertainty about COVID-19 outcomes in angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) users continues with contradictory findings. The aim of this study was to determine the effect of ACEI/ARB use in patients with severe COVID-19. Methods: This retrospective cohort study was done in two Saudi public specialty hospitals designated as COVID-19 referral facilities. We included 354 patients with confirmed diagnosis of COVID-19 between April and June 2020, of which 146 were ACEI/ARB users and 208 were non-ACEI/ARB users. Controlling for confounders, we conducted a multivariate logistic regression and a sensitivity analyses using propensity score matching (PSM) and Inverse propensity score weighting (IPSW) for high risk patient subsets. Results: Compared to non-ACEI/ARB users, ACEI/ARB users had an eight-fold higher risk of developing critical or severe COVID-19 (OR=8.25, 95%CI=3.32-20.53); a nearly 7-fold higher risk of intensive care unit (ICU) admission (OR=6.76, 95%CI=2.88-15.89) and a nearly 5-fold higher risk of requiring noninvasive ventilation (OR=4.77,95%CI=2.15-10.55). Patients with diabetes, hypertension, and/or renal disease had a five-fold higher risk of severe COVID-19 disease (OR=5.40,95%CI=2.0-14.54]. These results were confirmed in the PSM and IPSW analyses. Conclusion: In general, but especially among patients with hypertension, diabetes, and/or renal disease, ACEI/ARB use is associated with a significantly higher risk of severe or critical COVID-19 disease, and ICU care.

scholarly journals Renin-Angiotensin-Aldosterone-System inhibitor use in patients with COVID-19 infection and prevention of serious events: a cohort study in commercially insured patients in the US

2020 ◽  
Author(s):  
Maria C Schneeweiss ◽  
Sandra Leonard ◽  
Andrew Weckstein ◽  
Sebastian Schneeweiss ◽  
Jeremy Rassen
Keyword(s):  
Cohort Study ◽  
Protective Effect ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Channel Blockers ◽  
Converting Enzyme Inhibitors ◽  
Pharmacy Claims ◽  
Level Data ◽  
Therapy Interventions

Objectives: There is a lack of clarity regarding the role of angiotensin receptor blockers (ARB) or angiotensin converting enzyme inhibitors (ACEi) in interfering with the SARS-COV-2 binding on human cells and the resulting change in disease severity. We sought to assess the risk of hospitalization for COVID-19 and serious complications in current users of ARB or ACEi compared to users of dihydropyridine calcium channel blockers (dhpCCB). Design: Cohort study Setting: The analysis used de-identified, patient-level data from HealthVerity, linking longitudinal data from US medical and pharmacy claims, which contain information on inpatient or outpatient diagnoses, procedures and medication dispensing. Participants: We identified patients aged 40+ and free of chronic kidney disease (CKD) who were newly diagnosed COVID-19, between March 1, 2020 and May 30, 2020, and adherent to ACEi, ARB, or dhpCCB therapy. Interventions: Current use of an ACEi, ARB, or dhpCCB. Main outcome measures: We compared the 30-day risk of hospitalization for COVID-19 and serious complications. Results: Of 24,708 patients identified, 7,571 were current users of an ARB, 8,484 of an ACEi, and 8,653 of a dhpCCB. The unadjusted 30-day risk of hospitalization for COVID-19 was 2.66% among ARB users, and 2.90% among ACEi users and 3.68% in dhpCCB users. In the PS-matched cohort, the risk of hospitalization among ARB users was 17% lower as compared to dhpCCB (RR=0.83; 0.68-1.00), and the risk among ACE users was 10% lower as compared to dhpCCB (RR=0.90; 0.76-1.07). When including patients with pre-existing CKD, the protective effect of ARB (RR= 0.74; 0.62-0.88) and ACEi (RR=0.84; 0.71-0.99) was more pronounced. Conclusions: This cohort study showed that neither ARB nor ACEi use increase the risk of severe COVID-19 disease among those infected, and instead suggests that current use of ARB may offer a protective effect. This study found no evidence to support the discontinuation of ARB/ACEi therapy.

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