ACE-Inhibitors/Angiotensin Receptor Blockers and risk of death for people infected with COVID-19: a prospective cohort study

Purpose

65 million ACE inhibitors (ACE-I) and angiotensin receptor blockers (ARB) prescriptions were issued by GPs in the UK last year to treat hypertension, diabetes, myocardial infarct, renal disease and heart failure. Amongst patients affected with these conditions globally, coronavirus related mortality has been high (22%). Some reports suggest that use of ACE-I and ARBs may account for this increased risk of mortality. It is hypothesised that COVID-19 binds to target cells through angiotensin-converting enzyme 2 (ACE2). ACE-I and ARBs are both known to increase ACE2 expression thus potentially facilitating infection with COVID-19. To date, there has been no research to examine this hypothesis.

Aim

To examine the association between ACE-I or ARB use and risk of death amongst people infected with COVID-19 in the UK.

Methods

A prospective cohort study of COVID-19 infected adults using the RCGP Research and Surveillance Centre network of routinely collected GP records. This covers over 530 practices in England and a representative population of five million. Participant characteristics will be summarised by sociodemographic and clinical variables. Mixed logistic regression models will be constructed to quantify the association between ARB/ACEI prescriptions and death.

Implication

This research could provide rapid preliminary evidence on the epidemiology of the COVID-19 infected population and whether two of the most commonly prescribed drugs in primary care are associated with an increased risk of death. Our results have the potential to inform prescribing or alleviate substantial public concerns that are leading to non-compliance.