Use of renin–angiotensin–aldosterone system inhibitors and risk of COVID-19 requiring admission to hospital: a case-population study

This Spanish study (1139 cases and 11390 population controls) found that compared with the use of other antihypertensive drugs, current use of RAAS inhibitors was not associated with increased risk of COVID-19 requiring admission (OR 0.94; 95% CI 0.77-1.15).

SPS commentary:

A related comment discusses how there has been widespread speculation that use of RAAS inhibitors could lead to increased expression of ACE2 in the respiratory tract and thereby increase the risk of infection with COVID-19 and also the development of severe complications. Despite the absence of evidence to support this theory, there has been widespread concern among both patients and physicians.

Several observational cohort studies have now been published. In the current study, there was no difference between RAAS inhibitors and other antihypertensives for the main outcome and also no difference when considering monotherapy with ACE inhibitors (OR 0.83 [95% CI 0.62-1.12]) or angiotensin-receptor blocker monotherapy (0.87 [0.60-1.28]). The comment notes that although this study and the others available have a number of limitations, ‘all reached similar overarching conclusions from which a reasonable interpretation is that no evidence exists to support the speculation that RAAS inhibitors increase the risk of COVID-19.’  

The current study found a decreased risk of COVID-19 requiring admission to hospital among patients with diabetes who were users of RAAS inhibitors (adjusted OR 0.53, 95% CI 0.34-0.80). Findings from other studies have also suggested RAAS inhibitors may reduce risk of complications or death due to COVID-19 but this requires confirmation in randomised controlled trials. In the meantime the emerging observational evidence should help to provide a degree of reassurance.

A DTB article discusses recent European Medicines Agency advice on renin-angiotensin system medicines during Covid-19 pandemic, and advice from professional bodies.


The Lancet

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DTB article