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Mortality from angiotensin-converting enzyme-inhibitors and angiotensin receptor blockers in people infected with COVID-19: a cohort study of 3.7 million people

Mortality from angiotensin-converting enzyme-inhibitors and angiotensin receptor blockers in people infected with COVID-19: a cohort study of 3.7 million people
Mortality from angiotensin-converting enzyme-inhibitors and angiotensin receptor blockers in people infected with COVID-19: a cohort study of 3.7 million people
Background
Concerns have been raised that angiotensin-converting enzyme-inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) might facilitate transmission of severe acute respiratory syndrome coronavirus 2 leading to more severe coronavirus disease (COVID-19) disease and an increased risk of mortality. We aimed to investigate the association between ACE-I/ARB treatment and risk of death amongst people with COVID-19 in the first 6 months of the pandemic.

Methods
We identified a cohort of adults diagnosed with either confirmed or probable COVID-19 (from 1 January to 21 June 2020) using computerized medical records from the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) primary care database. This comprised 465 general practices in England, United Kingdom with a nationally representative population of 3.7 million people. We constructed mixed-effects logistic regression models to quantify the association between ACE-I/ARBs and all-cause mortality among people with COVID-19, adjusted for sociodemographic factors, comorbidities, concurrent medication, smoking status, practice clustering, and household number.

Results
There were 9,586 COVID-19 cases in the sample and 1,463 (15.3%) died during the study period between 1 January 2020 and 21 June 2020. In adjusted analysis ACE-I and ARBs were not associated with all-cause mortality (adjusted odds ratio [OR] 1.02, 95% confidence interval [CI] 0.85–1.21 and OR 0.84, 95% CI 0.67–1.07, respectively).

Conclusion
Use of ACE-I/ARB, which are commonly used drugs, did not alter the odds of all-cause mortality amongst people diagnosed with COVID-19. Our findings should inform patient and prescriber decisions concerning continued use of these medications during the pandemic.
0263-2136
Dambha-Miller, Hajira
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Hinton, W
e8f79032-e94c-40e9-9066-4d4ae69b626b
Wilcox, Christopher
e2c4c36a-e2e5-43a5-9fd6-7198cc15dd53
Lemanska, A
384079bd-2258-499c-8e1a-27c56f2094a6
Joy, M
530785e8-5a09-4168-9cd3-3c26533d4bcb
Feher, M
24a7248b-6094-4667-ba87-5a6f7371864c
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
de Lusignan, S
ed04b370-871d-400d-ab7e-85d76eec0d06
Hippisley-Cox, Julia
7be524e3-9066-4179-b58f-cb2e16cd02ec
Griffin, S
64b4f754-9673-488e-9e4a-c9e1a5188794
Dambha-Miller, Hajira
58961db5-31aa-460e-9394-08590c4b7ba1
Hinton, W
e8f79032-e94c-40e9-9066-4d4ae69b626b
Wilcox, Christopher
e2c4c36a-e2e5-43a5-9fd6-7198cc15dd53
Lemanska, A
384079bd-2258-499c-8e1a-27c56f2094a6
Joy, M
530785e8-5a09-4168-9cd3-3c26533d4bcb
Feher, M
24a7248b-6094-4667-ba87-5a6f7371864c
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
de Lusignan, S
ed04b370-871d-400d-ab7e-85d76eec0d06
Hippisley-Cox, Julia
7be524e3-9066-4179-b58f-cb2e16cd02ec
Griffin, S
64b4f754-9673-488e-9e4a-c9e1a5188794

Dambha-Miller, Hajira, Hinton, W, Wilcox, Christopher, Lemanska, A, Joy, M, Feher, M, Stuart, Beth, de Lusignan, S, Hippisley-Cox, Julia and Griffin, S (2022) Mortality from angiotensin-converting enzyme-inhibitors and angiotensin receptor blockers in people infected with COVID-19: a cohort study of 3.7 million people. Family Practice. (doi:10.1093/fampra/cmac094).

Record type: Article

Abstract

Background
Concerns have been raised that angiotensin-converting enzyme-inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) might facilitate transmission of severe acute respiratory syndrome coronavirus 2 leading to more severe coronavirus disease (COVID-19) disease and an increased risk of mortality. We aimed to investigate the association between ACE-I/ARB treatment and risk of death amongst people with COVID-19 in the first 6 months of the pandemic.

Methods
We identified a cohort of adults diagnosed with either confirmed or probable COVID-19 (from 1 January to 21 June 2020) using computerized medical records from the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) primary care database. This comprised 465 general practices in England, United Kingdom with a nationally representative population of 3.7 million people. We constructed mixed-effects logistic regression models to quantify the association between ACE-I/ARBs and all-cause mortality among people with COVID-19, adjusted for sociodemographic factors, comorbidities, concurrent medication, smoking status, practice clustering, and household number.

Results
There were 9,586 COVID-19 cases in the sample and 1,463 (15.3%) died during the study period between 1 January 2020 and 21 June 2020. In adjusted analysis ACE-I and ARBs were not associated with all-cause mortality (adjusted odds ratio [OR] 1.02, 95% confidence interval [CI] 0.85–1.21 and OR 0.84, 95% CI 0.67–1.07, respectively).

Conclusion
Use of ACE-I/ARB, which are commonly used drugs, did not alter the odds of all-cause mortality amongst people diagnosed with COVID-19. Our findings should inform patient and prescriber decisions concerning continued use of these medications during the pandemic.

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More information

Accepted/In Press date: 3 August 2022
e-pub ahead of print date: 25 August 2022
Published date: 25 August 2022
Additional Information: © The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Identifiers

Local EPrints ID: 470531
URI: http://eprints.soton.ac.uk/id/eprint/470531
ISSN: 0263-2136
PURE UUID: e915a8f6-d647-4c56-a48d-57ac2c7177e5
ORCID for Hajira Dambha-Miller: ORCID iD orcid.org/0000-0003-0175-443X
ORCID for Beth Stuart: ORCID iD orcid.org/0000-0001-5432-7437

Catalogue record

Date deposited: 12 Oct 2022 16:45
Last modified: 16 Nov 2022 02:51

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Contributors

Author: W Hinton
Author: A Lemanska
Author: M Joy
Author: M Feher
Author: Beth Stuart ORCID iD
Author: S de Lusignan
Author: Julia Hippisley-Cox
Author: S Griffin

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