Association of Renin-Angiotensin-Aldosterone Inhibitors with COVID-19 Infection and Disease Severity among Individuals with Hypertension

Moria Mahanaimy, Uriah Finkel, Noam Barda, Eytan Roitman, Ran Balicer, Adi Berliner Senderey, Becca Feldman

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The association between use of renin-angiotensin-aldosterone (RMS) inhibitors and both SARS-CoV-2 infection and the development of severe COVID-19 has been presented in the recent medical literature with inconsistent results. Objectives: To assess the association between RAAS inhibitor use and two outcomes: infection with SARS-CoV-2 (Model 1) and severe COVID-19 among those infected (Model 2). Methods: We accessed used electronic health records of individuals from Israel who were receiving anti-hypertensive medications for this retrospective study. For Model 1 we used a case-control design. For Model 2 we used a cohort design. In both models, inverse probability weighting adjusted for identified confounders as part of doubly robust outcome regression. Results: We tested 38,554 individuals for SARS-CoV-2 who had hypertension and were being treated with medication; 691 had a positive test result. Among those with a positive test, 119 developed severe illness. There was no association between RAAS inhibitor use and a positive test. Use of RAAS inhibitors was associated with a decreased risk for severe COVID-19 (adjusted odds ratio [OR] 0.47, 95% confidence interval [95%CI] 0.29-0.77) compared with users of non-RAAS anti-hypertensive medication. The association remained significant when use of angiotensin-converting-enzyme inhibitors (adjusted OR 0.46, 95%CI 0.27-0.77) and angiotensin II receptor blockers (adjusted OR 0.39,95%CI 0.16-0.95) were analyzed separately. Conclusions: Among individuals with hypertension using RAAS inhibitors, we found a lower risk of severe disease compared to those using non-RAAS anti-hypertensive medications. This finding suggests that RAAS inhibitors may have a protective effect on COVID-19 severity among individuals with medically treated hypertension.

Original languageEnglish
Pages (from-to)310-316
Number of pages7
JournalIsrael Medical Association Journal
Volume24
Issue number5
StatePublished - 1 May 2022

Keywords

  • angiotensin II receptor blockers (ARB)
  • angiotensin-converting-enzyme inhibitors (ACEI)
  • coronavirus disease 2019 (COVID-19)
  • renin-angiotensin-aldosterone (RAAS) inhibitors
  • severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

ASJC Scopus subject areas

  • Medicine (all)

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