ABSTRACT
Background Angiotensin converting enzyme (ACE) type 2 is the receptor of SARS-CoV-2 for entry into lungs cells. Because ACE-2 may be modulated by ACE inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), there is concern that patients treated with ACEIs and ARBs are at higher risk for COVID-19 infection.
Aim This study sought to analyze the association of COVID-19 with previous treatment with ACEI and ARB.
Methods We retrospectively reviewed 684 consecutive patients hospitalized for suspected COVID-19 pneumonia and tested by PCR. Patients were split into 2 groups, whether (group 1, n=484) or not (group 2, n=250) COVID-19 was confirmed. Multivariate adjusted comparisons included a propensity score analysis.
Results Age was 63.6±18.7 years, and 302(44%) were female. Hypertension was present in 42.6% and 38.4% patients of group 1 and 2, respectively (P=0.28). A treatment with ARBs (20.7% versus 12.0%, respectively, OR 1.92, 95% confidence interval [1.23-2.98], p=0.004) was more frequent in patients of group 1 than in group 2. No difference was found for treatment with ACEIs (12.7% vs 15.7%, respectively, OR 0.81 [0.52-1.26], p=0.35). Propensity score matched multivariate logistic regression confirmed a significant association between COVID-19 and a previous treatment with ARBs (adjusted OR 2.18 [1.29-3.67], p=0.004). Significant interaction between ARBs and ACEIs for the risk of COVID-19 was observed in patients aged>60, women, and hypertensive patients.
Conclusion This study suggests that ACEIs and ARBs are not similarly associated with the COVID-19. In this retrospective series, patients with COVID-19 pneumonia received more frequently a previous treatment with ARBs, than patients without COVID-19.
Competing Interest Statement
JLG has received consultant or speaker fees from AstraZeneca France, Sanofi-Aventis, Amgen, and Merck Sharpe and Dohme, which are not related to the present work. No conflicts of interest were disclosed for the other authors.
Clinical Trial
NCT04374695
Funding Statement
This study was founded by the Centre Hospitalier de Versailles, Le Chesnay, France. The authors received no specific funding for this work.
Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
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This study was approved by Comite de Protection des personnes Ouest VI (CPP Ouest 6; CPP 1296 HPS3; Number 2020 A01516 33) Written consent of patients was obtained
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