Abstract 15213: Association of Angiotensin-converting Enzyme Inhibitors or Angiotensin Receptor Blockers Use and Covid-19 Infection Among Patients With Hypertension

Abstract

Introduction: Given the limited evidence, we investigated the association between use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) and risk of Covid-19 infection within a large diverse hypertension population. Methods: We identified patients with hypertension as of March 1, 2020 (index date) from Kaiser Permanente Southern California, a large US integrated healthcare system. Patient demographics, antihypertensive medication use, neighborhood income and education, and comorbidities were identified from electronic health records within 1-year pre-index date. The study outcome was a positive RT-PCR test for Covid-19 between March 1 - May 6, 2020. We used multivariable logistic regression models to examine the association between ACEI/ARB use and Covid-19 infection. Results: Among 824,650 patients with hypertension, 16,898 (2.0%) were tested for Covid-19. Of those tested, 1,794 (10.6%) had a positive result and 547 (30.5% of positive cases) were hospitalized within 14-days of testing positive. Of those tested, 4,878 (28.9%) were on ACEIs, 3,473 (20.6%) were on ARBs, and 4,177 (24.7%) were on other antihypertensive medication classes. Risk of covid-19 infection associated with ACEI use decreased with increasing age (P-interaction = 0.01). In age-stratified analyses, ACEI use was not statistically associated with increased risk of Covid-19 infection among the age groups of 18-39, 40-64, and 65-84 years but was associated with lower risk of Covid-19 among those aged ≥85 years ( Table ). Across all age groups, ARB use was not associated with increased risk of Covid-19, but non-white race, lower neighborhood income and education, and no antihypertensive medication use were associated with increased risk of Covid-19. Conclusions: ACEI nor ARB use was not associated with increased risk of Covid-19 infection. The decreased risk of Covid-19 infection among older adults using ACEIs warrants further investigation.