Association Between Baseline Use of Angiotensin‐Converting Enzyme Inhibitors and Angiotensin Receptor Blockers and Death Among Patients Tested for COVID‐19

Angiotensin‐converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) drugs may modify risk associated with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Therefore, we assessed whether baseline therapy with ACEIs or ARBs was associated with lower mortality, respiratory failure (noninvasive ventilation or intubation), and renal failure (new renal replacement therapy) in SARS‐CoV‐2‐positive patients. This retrospective registry‐based observational cohort study used data from a national database of emergency department patients tested for SARS‐CoV‐2. Symptomatic emergency department patients were accrued from January to October 2020, across 197 hospitals in the United States. Multivariable analysis using logistic regression evaluated end points among SARS‐CoV‐2–positive cases, focusing on ACEIs/ARBs and adjusting for covariates. Model performance was evaluated using the c statistic for discrimination and Cox plotting for calibration. A total of 13 859 (99.9%) patients had known mortality status, of whom 2045 (14.8%) died. Respiratory failure occurred in 2485/13 880 (17.9%) and renal failure in 548/13 813 (4.0%) patients with available data. ACEI/ARB status was associated with a 25% decrease in mortality odds (odds ratio [OR], 0.75; 95%CI, 0.59‐0.94; P = .011; c = .82). ACEIs/ARBs were not significantly associated with respiratory failure (OR, 0.89; 95%CI, 0.78‐1.06; P = .206) or renal failure (OR, 0.75; 95%CI, 0.55‐1.04; P = .083). Adjusting for covariates, baseline ACEI/ARB was associated with 25% lower mortality in SARS‐CoV‐2–positive patients. The potential mechanism for ACEI/ARB mortality modification requires further exploration.