Common BP-lowering drugs may positively affect COVID-19 susceptibility, severity

The use of antihypertensive drugs, such as angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), cuts the risk of contracting COVID-19 or receiving ICU care once infected, according to a study. However, the beneficial effect on disease susceptibility appears to be ethnic-specific.

Researchers collected data from 1,205 general practices in England with 8.28 million participants (median age, 47 years; 49.73 percent male) aged 20–99 years. They identified 19,486 patients with COVID-19 (mean age, 62.18 years; 48.12 percent male), among whom 1,286 received ICU care.

In the entire population, 6,691,660 (80.9 percent) participants had available data on self-assigned ethnicity: 84.10 percent were white, 2.76 percent Indian, 2.41 percent black, 1.78 percent Pakistani, 1.33 percent Bangladeshi, 1.14 percent Caribbean, 1 percent Chinese, 1.77 percent other Asian, and 3.71 percent others.

Overall, 645,577 participants (7.8 percent) were ACE inhibitor users, and 308,881 (3.7 percent) were ARB users. Among COVID-19 patients, the corresponding numbers were 2,864 (14.70 percent) and 1,417 (7.27 percent).

Cox proportional hazards models controlled for a wide range of confounders showed that ACE inhibitors were associated with a significantly lower risk of incident COVID-19 (adjusted hazard ratio [HR], 0.71, 95 percent confidence interval [CI], 0.67–0.74) and no excess risk of ICU care among infected patients (adjusted HR, 0.89, 95 percent CI, 0.75–1.06).

The same was true among ARB users, with adjusted HRs of 0.63 (95 percent CI, 0.59–0.67) for incident COVID-19 and 1.02 (95 percent CI, 0.83–1.25) for ICU care.

There were significant interactions between ethnicity and ACE inhibitors and ARBs for COVID-19 susceptibility. The risk of contracting COVID-19 associated with ACE inhibitors was higher in Caribbean (adjusted HR, 1.05, 95 percent CI, 0.87–1.28) and black (adjusted HR, 1.31, 95 percent CI, 1.08–1.59) groups than in the white group (adjusted HR, 0.66, 95 percent CI, 0.63–0.70). Meanwhile, a higher risk of COVID-19 among ARB users was noted for blacks (adjusted HR, 1.24, 95 percent CI, 0.99–1.58) than whites (adjusted HR, 0.56, 95 percent CI, 0.52–0.62).

The findings suggest the possibility of ethnic-specific effects of ACE inhibitors and ARBs on COVID-19 risk, which deserves further study, according to the researchers.