Use of distinct anti‐hypertensive drugs and risk for COVID‐19 among hypertensive people: A population‐based cohort study in Southern Catalonia, Spain

Abstract

The use of some anti‐hypertensive drugs in the current COVID‐19 pandemic has become controversial. This study investigated possible relationships between anti‐hypertensive medications use and COVID‐19 infection risk in the ambulatory hypertensive population. This is a population‐based retrospective cohort study involving 34 936 hypertensive adults >50 years in Tarragona (Southern Catalonia, Spain) who were retrospectively followed through pandemic period (from 01/03/2020 to 30/04/2020). Two data sets including demographic/clinical characteristics (comorbidities and cardiovascular medications use) and laboratory PCR codes for COVID‐19 were linked to construct an anonymized research database. Cox regression was used to calculate multivariable hazard ratios (HRs) and estimate the risk of suffering COVID‐19 infection. Across study period, 205 PCR‐confirmed COVID‐19 cases were observed, which means an overall incidence of 586.8 cases per 100 000 persons‐period. In multivariable analyses, only age (HR: 1.03; 95% CI: 1.02‐1.05; P < .001) and nursing home residence (HR: 19.60; 95% CI: 13.80‐27.84; P < .001) appeared significantly associated with increased risk of COVID‐19. Considering anti‐hypertensive drugs, receiving diuretics (HR: 1.22; 95% CI: 0.90‐1.67; P = .205), calcium channel blockers (HR: 1.29; 95%CI: 0.91‐1.82; P = .148), beta‐blockers (HR: 0.97; 95% CI: 0.68‐1.37; P = .844), and angiotensin‐converting enzyme inhibitors (HR: 0.83; 95% CI: 0.61‐1.13; P = .238) did not significantly alter the risk of PCR‐confirmed COVID‐19, whereas receiving angiotensin II receptor blockers was associated with an almost statistically significant reduction risk (HR: 0.67; 95% CI: 0.44‐1.01; P = .054). In conclusion, our data support that receiving renin‐angiotensin‐aldosterone system inhibitors does not predispose for suffering COVID‐19 infection in ambulatory hypertensive people. Conversely, receiving angiotensin II receptor blockers could be related with a reduced risk.

A comprehensive guide to the pharmacologic regulation of angiotensin converting enzyme 2 (ACE2), the SARS-CoV-2 entry receptor

“…In a population based retrospective study of 34,936-hypertensive adults, the use of antihypertensive drugs, including diuretics, CCBs, βARBs, ACE-Inhs. and ARBs, did not alter the risk of COVID-19 ( Vila-Corcoles et al, 2020 ). Similarly, in a recent study analyzing 6,272 COVID-19 patients, no association between the use of ACE-Inhs.…”

Hypertension, medications, and risk of severe COVID‐19: A Massachusetts community‐based observational study

“…With conflicting mechanistic evidence concerning risk of SARS‐CoV‐2 from some of the most widely used drugs for cardiovascular disease, HT and diabetes, an urgent request for epidemiologic evidence was issued to attempt to determine the role of RAS inhibitors in relation to SARS‐CoV‐2 severity 1 . To date, several studies of hospitalized (HT) COVID‐19 patients suggest no association with severe infections or mortality 11–15 …”

“…1 To date, several studies of hospitalized (HT) COVID-19 patients suggest no association with severe infections or mortality. [11][12][13][14][15] In this community-based case-control study of central Massachusetts COVID-19 patients, we investigated whether RAS inhibitors exposure increased the risk of severe sequelae defined as hospitalization or death. Additionally, we investigated the novel hypothesis that the diuretic thiazide, often prescribed for HT in conjunction with RAS inhibitors, may modify the risk of severe SARS-CoV-2.…”

Do proton pump inhibitors influence SARS-CoV-2 related outcomes? A meta-analysis

“…Six studies [1][2][3][4][5][6] including 318 261 participants reported data on PPI usage and the risk of SARS-CoV-2 infection. Among them, five studies had information of current PPI users compared with nonusers and four on past PPI users versus non-users.…”

“…Analysis of five studies [1][2][3][4][5] encompassing 145 428 patients who were tested for SARS-CoV-2 showed that the risk of SARS-CoV-2 infection was higher, although not significantly, among current PPI users (OR 1.33, 95% CI 0.86 to 2.07, p=0.20; figure 1) compared with PPI non-users, with evidence of substantial between-study heterogeneity (I 2 =97%). Moreover, in a subgroup analysis of non-Korean cohorts, [2][3][4] we found a significant association between current use of PPIs and increased risk of SARS-CoV-2 infection (OR 1.94, 95% CI 1.59 to 2.36, p<0.0001; online supplemental figure 2). Furthermore, a leave-one-out sensitivity analysis revealed that the summary estimate of the association between current PPI usage and SARS-CoV-2 infection was overly influenced by a single Korean study 5 (online supplemental figure 3).…”