Sandeep Singh1,2, Christine Widrich3, Martijn Nap3, Emile Schokker4, Aeilko H Zwinderman1, Sara-Joan Pinto-Sietsma1,2. 1. Departments of Clinical Epidemiology, Biostatistics and Bio-informatics, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands. 2. Department of Vascular Medicine, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands. 3. IQVIA, Amsterdam, The Netherlands. 4. IQVIA, Frankfurt, Germany.
Abstract
BACKGROUND: Role of antihypertensive, especially Renin-Angiotensin-Aldosterone System (RAAS) inhibitors are 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. METHODS: Association between percentage use of different types of anti-hypertensive medications and mortality rates due to a SARS-CoV-2 infection during the first three weeks of the pandemic were analyzed using random effects linear regression models for 30 countries worldwide. RESULT: Both a higher percentages of prescribed angiotensin receptor blockers (ARBs) [β, 95% CI; -0.02(-0.04- -0.0012); p=0.042] and calcium channel blockers (CCB) [β, 95% CI; -0.023 (-0.05- -0.0028); p=0.0304] were associated with a lower first 3-week SARS-CoV-2 related death rate, whereas higher percentages of prescribed angiotensin converting enzyme inhibitors (ACEi) [β, 95% CI; 0.03 (0.0061-0.05); p=0.0103] was associated with a higher first 3-week death rate, even when adjusted for age and metformin use. There was no association of the amount of prescribed beta blockers (BB) and diuretics (Diu) and first 3-week death rate. When analyzing which combination of drugs are used by at least 50% of antihypertensive users, within the different countries, countries with the lowest first 3-week death rates all had at least an angiotensin receptor blocker as one of the most often prescribed antihypertensive medications ( (ARBs)/ (CCB) (β, 95% CI; -0.02 (-0.03- -0.004); p=0.009), ARBs/ (BB) (β, 95% CI; -0.03 (-0.05- -0.006); p=0.01)). Finally, countries prescribing high potency ARB's, had lower first 3-week death rates than countries prescribing low potency ARB's. CONCLUSION: In conclusion ARBs and CCB seems to have protective effect from dying with SARS-CoV-2 infection. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
BACKGROUND: Role of antihypertensive, especially Renin-Angiotensin-Aldosterone System (RAAS) inhibitors are 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. METHODS: Association between percentage use of different types of anti-hypertensive medications and mortality rates due to a SARS-CoV-2 infection during the first three weeks of the pandemic were analyzed using random effects linear regression models for 30 countries worldwide. RESULT: Both a higher percentages of prescribed angiotensin receptor blockers (ARBs) [β, 95% CI; -0.02(-0.04- -0.0012); p=0.042] and calcium channel blockers (CCB) [β, 95% CI; -0.023 (-0.05- -0.0028); p=0.0304] were associated with a lower first 3-week SARS-CoV-2 related death rate, whereas higher percentages of prescribed angiotensin converting enzyme inhibitors (ACEi) [β, 95% CI; 0.03 (0.0061-0.05); p=0.0103] was associated with a higher first 3-week death rate, even when adjusted for age and metformin use. There was no association of the amount of prescribed beta blockers (BB) and diuretics (Diu) and first 3-week death rate. When analyzing which combination of drugs are used by at least 50% of antihypertensive users, within the different countries, countries with the lowest first 3-week death rates all had at least an angiotensin receptor blocker as one of the most often prescribed antihypertensive medications ( (ARBs)/ (CCB) (β, 95% CI; -0.02 (-0.03- -0.004); p=0.009), ARBs/ (BB) (β, 95% CI; -0.03 (-0.05- -0.006); p=0.01)). Finally, countries prescribing high potency ARB's, had lower first 3-week death rates than countries prescribing low potency ARB's. CONCLUSION: In conclusion ARBs and CCB seems to have protective effect from dying with SARS-CoV-2 infection. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Authors: Sandeep Singh; Annette K Offringa-Hup; Susan J J Logtenberg; Paul D Van der Linden; Wilbert M T Janssen; Hubertina Klein; Femke Waanders; Suat Simsek; Cornelis P C de Jager; Paul Smits; Machteld van der Feltz; Gerrit Jan Beumer; Christine Widrich; Martijn Nap; Sara-Joan Pinto-Sietsma Journal: Hypertension Date: 2021-06-09 Impact factor: 10.190