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Association of Renin--Angiotensin--Aldosterone System Blocker use with Covid-19 Hospitalization and All-cause Mortality in the UK Biobank
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  • Fatemeh Safizadeh,
  • Thi Ngoc Mai Nguyen,
  • Hermann Brenner,
  • Ben Schöttker
Fatemeh Safizadeh
Ludwig-Maximilians-Universität München
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Thi Ngoc Mai Nguyen
Deutsches Krebsforschungszentrum
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Hermann Brenner
Deutsches Krebsforschungszentrum
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Ben Schöttker
Deutsches Krebsforschungszentrum
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Abstract

Aim: The risk-benefit profile of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in coronavirus disease 2019 (Covid-19) is still a matter of debate. With growing evidence on the protective effect of this group of commonly used antihypertensives in Covid-19, we aimed to thoroughly investigate the association between the use of major classes of antihypertensive medications and Covid-19 outcomes in comparison with the use of ACEIs and ARBs. Methods: We conducted a population-based study in patients with pre-existing hypertension in the UK Biobank. Multivariable logistic regression analysis was performed adjusting for a wide range of confounders. Results: The use of either beta-blockers (BBs), calcium-channel blockers (CCBs), or diuretics was associated with a higher risk of Covid-19 hospitalization compared to ACEI use (adjusted OR, 1.63; 95% CI, 1.40 to 1.90) and ARB use (adjusted OR, 1.50; 95% CI, 1.27 to 1.77). The risk of 28-day mortality among Covid-19 patients was also increased among users of BBs, CCBs or diuretics when compared to ACEI users (adjusted OR, 1.64; 95% CI, 1.23 to 2.19) but not when compared to ARB users (adjusted OR, 1.18; 95% CI, 0.87 to 1.59). However, no associations were observed when the same analysis was conducted among hospitalized Covid-19 patients only. Conclusion: Our results suggest protective effects of blocking of the renin-angiotensin-aldosterone system on Covid-19 hospitalization and mortality among patients with pharmaceutically treated hypertension, which should be addressed by randomized controlled trials. If confirmed, this finding could have high clinical relevance for treating hypertension during the SARS-CoV-2 pandemic.
17 Aug 2021Submitted to British Journal of Clinical Pharmacology
18 Aug 2021Submission Checks Completed
18 Aug 2021Assigned to Editor
24 Aug 2021Reviewer(s) Assigned
10 Sep 2021Review(s) Completed, Editorial Evaluation Pending
20 Sep 2021Editorial Decision: Revise Major
19 Nov 20211st Revision Received
22 Nov 2021Submission Checks Completed
22 Nov 2021Assigned to Editor
22 Nov 2021Review(s) Completed, Editorial Evaluation Pending
05 Dec 2021Editorial Decision: Accept