TY - JOUR
T1 - Antihypertensives and their relation to mortality by SARS-CoV-2 infection
AU - Singh, Sandeep
AU - Widrich, Christine
AU - Nap, Martijn
AU - Schokker, Emile
AU - Zwinderman, Aeilko H.
AU - Pinto-Sietsma, Sara-Joan
N1 - Publisher Copyright: © 2021 The Authors. Journal of Medical Virology Published by Wiley Periodicals LLC
PY - 2021/4
Y1 - 2021/4
N2 - The role of antihypertensives, especially Renin–Angiotensin–Aldosterone System inhibitors, is still debatable in COVID-19-related severity and outcome. Therefore, we search for a more global analysis of antihypertensive medication in relation to SAS-CoV-2 severity using prescription data worldwide. The association between the percentage use of different types of antihypertensive medications and mortality rates due to a SARS-CoV-2 infection during the first 3 weeks of the pandemic was analyzed using random effects linear regression models for 30 countries worldwide. Higher percentages of prescribed angiotensin receptor blockers (ARBs) (β, 95% confidence interval [CI]; −0.02 [−0.04 to −0.0012]; p =.042) and calcium channel blockers (CCBs) (β, 95% CI; −0.023 [−0.05 to −0.0028]; p =.0304) were associated with a lower first 3-week SARS-CoV-2-related death rate, whereas a higher percentage of prescribed angiotensin-converting enzyme inhibitors (ACEis) (β, 95% CI; 0.03 [0.0061–0.05]; p =.0103) was associated with a higher first 3-week death rate, even when adjusted for age and metformin use. There was no association between the amount of prescribed beta-blockers (BBs) and diuretics (Diu) and the first 3-week death rate. When analyzing the combination of drugs that is used by at least 50% of antihypertensive users, within the different countries, countries with the lowest first 3-week death rates had at least an angiotensin receptor blocker as one of the most often prescribed antihypertensive medications (ARBs/CCBs: [β, 95% CI; −0.02 [−0.03 to −0.004]; p =.009], ARBs/BBs: [β, 95% CI; −0.03 [−0.05 to −0.006]; p =.01]). Finally, countries prescribing high-potency ARBs had lower first 3-week ARBs. In conclusion, ARBs and CCB seem to have a protective effect against death from SARS-CoV-2 infection.
AB - The role of antihypertensives, especially Renin–Angiotensin–Aldosterone System inhibitors, is still debatable in COVID-19-related severity and outcome. Therefore, we search for a more global analysis of antihypertensive medication in relation to SAS-CoV-2 severity using prescription data worldwide. The association between the percentage use of different types of antihypertensive medications and mortality rates due to a SARS-CoV-2 infection during the first 3 weeks of the pandemic was analyzed using random effects linear regression models for 30 countries worldwide. Higher percentages of prescribed angiotensin receptor blockers (ARBs) (β, 95% confidence interval [CI]; −0.02 [−0.04 to −0.0012]; p =.042) and calcium channel blockers (CCBs) (β, 95% CI; −0.023 [−0.05 to −0.0028]; p =.0304) were associated with a lower first 3-week SARS-CoV-2-related death rate, whereas a higher percentage of prescribed angiotensin-converting enzyme inhibitors (ACEis) (β, 95% CI; 0.03 [0.0061–0.05]; p =.0103) was associated with a higher first 3-week death rate, even when adjusted for age and metformin use. There was no association between the amount of prescribed beta-blockers (BBs) and diuretics (Diu) and the first 3-week death rate. When analyzing the combination of drugs that is used by at least 50% of antihypertensive users, within the different countries, countries with the lowest first 3-week death rates had at least an angiotensin receptor blocker as one of the most often prescribed antihypertensive medications (ARBs/CCBs: [β, 95% CI; −0.02 [−0.03 to −0.004]; p =.009], ARBs/BBs: [β, 95% CI; −0.03 [−0.05 to −0.006]; p =.01]). Finally, countries prescribing high-potency ARBs had lower first 3-week ARBs. In conclusion, ARBs and CCB seem to have a protective effect against death from SARS-CoV-2 infection.
KW - CVOID-19
KW - RAAS blockers
KW - SARS-CoV-2
KW - angiotensin receptor blockers
KW - angiotensin-converting enzyme inhibitor
UR - http://www.scopus.com/inward/record.url?scp=85099758549&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/jmv.26775
DO - https://doi.org/10.1002/jmv.26775
M3 - Article
C2 - 33404127
SN - 0146-6615
VL - 93
SP - 2467
EP - 2475
JO - Journal of Medical Virology
JF - Journal of Medical Virology
IS - 4
ER -