It remains uncertain whether the hypertension (HT) medications angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) mitigate or exacerbate SARS-CoV-2 infection We evaluated the association of ACEi and ARB with severe coronavirus disease 19 (COVID-19) as defined by hospitalization or mortality among individuals diagnosed with COVID-19 We investigated whether these associations were modified by age, the simultaneous use of the diuretic thiazide, and the health conditions associated with medication use In an observational study utilizing data from a Massachusetts group medical practice, we identified 1449 patients with a COVID-19 diagnosis In our study, pre-infection comorbidities including HT, cardiovascular disease, and diabetes were associated with increased risk of severe COVID-19 Risk was further elevated in patients under age 65 with these comorbidities or cancer Twenty percent of those with severe COVID-19 compared to 9% with less severe COVID-19 used ACEi, 8% and 4%, respectively, used ARB In propensity score-matched analyses, use of neither ACEi (OR = 1 30, 95% CI 0 93 to 1 81) nor ARB (OR = 0 94, 95% CI 0 57 to 1 55) was associated with increased risk of severe COVID-19 Thiazide use did not modify this relationship Beta blockers, calcium channel blockers, and anticoagulant medications were not associated with COVID-19 severity In conclusion, cardiovascular-related comorbidities were associated with severe COVID-19 outcomes, especially among patients under age 65 We found no substantial increased risk of severe COVID-19 among patients taking antihypertensive medications Our findings support recommendations against discontinuing use of renin-angiotensin system (RAS) inhibitors to prevent severe COVID-19
Hypertension, medications, and risk of severe COVID-19: A Massachusetts community-based observational study