There are plausible mechanisms by which angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may increase the risk of COVID-19 infection or affect disease severity To examine the association between these medications and COVID-19 infection or hospitalization, we conducted a retrospective cohort study within a US integrated healthcare system Among people aged &gt;/=18 years enrolled in the health plan for at least 4 months as of 2/29/2020, current ACEI and ARB use was identified from pharmacy data, and the estimated daily dose was calculated and standardized across medications COVID-19 infections were identified through 6/14/2020 from laboratory and hospitalization data We used logistic regression to estimate adjusted odds ratios (ORs) and 95% confidence intervals Among 322,044 individuals, 720 developed COVID-19 infection Among people using ACEI/ARBs, 183/56,105 developed COVID-19 (3 3 per 1000 individuals) compared with 537/265,939 without ACEI/ARB use (2 0 per 1000), yielding an adjusted OR of 0 94 (95% CI 0 75-1 16) For use of /=2 defined daily doses, 0 94 (95% CI 0 72-1 23) The OR was similar for ACEIs and ARBs and in subgroups by age and sex 29% of people with COVID-19 infection were hospitalized;the adjusted OR for hospitalization in relation to ACEI/ARB use was 0 92 (95% CI 0 54-1 57), and there was no association with dose These findings support current recommendations that individuals on these medications continue their use
Renin-angiotensin-aldosterone system inhibitors and COVID-19 infection or hospitalization: a cohort study