Angiotensin II receptor blocker or angiotensin-converting enzyme inhibitor use and COVID-19-related outcomes among US Veterans

April 23, 2021

Catherine G. Derington ,Jordana B. Cohen,April F. Mohanty,Tom H. Greene,James Cook,Jian Ying,Guo Wei,Jennifer S. Herrick,Vanessa W. Stevens,Barbara E. Jones,Libo Wang,Alexander R. Zheutlin,Andrew M. South,Thomas C. Hanff,Steven M. Smith,Rhonda M. Cooper-DeHoff,Jordan B. King,G. Caleb Alexander,Dan R. Berlowitz,Faraz S. Ahmad,M. Jason Penrod,Rachel Hess,Molly B. Conroy,James C. Fang,Michael A. Rubin,Srinivasan Beddhu,Alfred K. Cheung,Weiming Xian,William S. Weintraub,Adam P. Bress


Derington et al. sought to examine the effects of angiotensin II receptor blocker (ARB), and angiotensin-converting enzyme inhibitor (ACEI) use on US Veterans with treated hypertension and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In a retrospective cohort study, the experimenters analyzed data from the Veterans Health Administration (VHA) to derived separate outpatient and inpatient cohorts. The study was conducted on US veterans who tested positive between January 19, 2020, and October 15, 2020, met one-year continuous enrollment criteria and treated hypertension as ≥ 1 inpatient or ≥ 2 outpatient encounters. Furthermore, two exposure groups were compared: users of any ARB and/or ACEI vs. non-users of any ARB and/or ACEI, and users of an ARB vs. users of an ACEI. First, researchers determined that, for both inpatients and outpatients, current use of an ARB/ACEI was associated with a lower relative risk of COVID-19 related outcomes (all-cause mortality, ICU admission, dialysis, and/or mechanical ventilation). When evaluating ARB vs. ACEI, the group found no evidence of a significant association between ARB vs. ACEI users for hospitalization or mortality for the inpatient cohort but found a relatively lower risk in outpatient ARB users vs. ACEI users. The outcomes of this study reinforce the results of other small, randomized trials that also reported no increased risk of harm with ARB and/or ACEI usage for adults hospitalized for COVID-19. Tentatively, such findings provide reassurance of the continued use of ARBs and/or ACEIs among patients with an ongoing SARS-CoV-2 infection.

Derington CG, Cohen JB, Mohanty AF, et al. Angiotensin II receptor blocker or angiotensin-converting enzyme inhibitor use and COVID-19-related outcomeamong US Veterans. PLoS One 2021; 16: e0248080.

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