Effect Of The Baseline Use Of Angiotensin-Converting Enzyme Inhibitors (Aceis) Or Angiotensin-Receptor Blockers (Arbs) On Outcomes Of Patients With Suspected Or Positive Covid-19 Infection

Introduction: SARS-CoV-2 requires the ACE-2 receptor to gain cellular entry, leading to concerns as to whether the use of ACEIs/ARBs may adversely affect patients (pts) exposed to the virus. Because of the potential for multiple confounding variables, determining their real impact through observational study may require the use of a carefully adjusted dataset. Methods: We collected data, including baseline characteristics and medication use, on 104,018 pts tested at Intermountain Healthcare for SARS-CoV-2 up to June 8, 2020, and determined their hospitalization and intensive care unit (ICU) admission status. We used multivariable regression analysis to ascertain the independent effect of the baseline use of ACEIs or ARBs on the risk of each outcome. Results: Tables 1 and 2 show baseline characteristics, including the use of ACEIs/ARBS, of test-positive versus -negative pts and, among test-positive pts, who did or did not require hospitalization and ICU care, respectively. In the entire cohort, test-negative pts were more likely to have multiple comorbidities and on ACEIs/ARBs. In the test-positive group, hospitalized patients were more likely to have comorbidities and to be taking ACEIs/ARBs. However, after multivariable adjustment, the baseline use of ACEIs/ARBs was associated with a reduced likelihood of being test-positive (OR=0.87, p=0.04), a reduced need for hospitalization (OR = 0.58, p=0.004), and a numerically reduced need for ICU placement (OR = 0.74, p=0.32). Conclusions: Selection bias regarding viral testing likely influenced the baseline characteristics of the entire tested population. Test-positive patients requiring hospitalization also had more comorbidities and used more ACEIs/ARBs. However, after multivariable adjustment, because of a strong correlation with comorbidities, the use of ACEIs/ARBs became associated with a reduced need for hospitalization and ICU admission. These findings provide further evidence of ACEI/ARB safety.