The first was the national registry of COVID-19 RT-PCR test positive results held by Public Health England (PHE)
The first was the national registry of COVID-19 RT-PCR test positive results held by Public Health England (PHE). 19?486 patients who had COVID-19 disease, 1286 received ICU care. ACE inhibitors were associated with a significantly reduced SB 431542 risk of COVID-19 disease (adjusted HR 0.71, 95%?CI 0.67 to 0.74) but no increased risk of ICU care (adjusted HR 0.89, 95%?CI 0.75 to 1 1.06) after adjusting for a wide range of confounders. Adjusted HRs for ARBs were 0.63 (95% CI 0.59 to 0.67) for COVID-19 disease and 1.02 (95% CI 0.83 to 1 1.25) for ICU care. There were significant interactions between ethnicity and ACE inhibitors and ARBs for COVID-19 disease. The risk of COVID-19 disease associated with ACE inhibitors was higher in Caribbean (adjusted HR 1.05, 95% CI 0.87 to 1 1.28) and Black African (adjusted HR 1.31, 95% CI 1.08 to 1 1.59) groups than the white group (adjusted HR 0.66, 95%?CI 0.63 to 0.70). A higher risk of COVID-19 with ARBs was seen for Black African (adjusted HR 1.24, 95%?CI 0.99 to 1 1.58) than the white (adjusted HR 0.56, 95%?CI 0.52 to 0.62) group. Interpretation ACE inhibitors and ARBs are associated with reduced risks of COVID-19 disease after adjusting for a wide range of variables. Neither ACE inhibitors nor ARBs are associated with significantly increased risks of receiving ICU care. Variations between different ethnic groups raise the possibility of ethnic-specific effects of ACE inhibitors/ARBs on COVID-19 disease susceptibility and severity which deserves further study. Keywords: primary care, epidemiology, hypertension, diabetes, cardiac risk factors Lepr and prevention Introduction The first cases of infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (COVID-19) in the UK were confirmed on 24 January 2020. Since then the disease has spread rapidly through the population. There are no vaccines, preventative or curative treatments for COVID-19 disease and only one possible disease-modifying treatment1 so the government has used social distancing as a population-level intervention to limit the rate of increase in cases. Case series of confirmed COVID-19 have identified age,2 sex,3 comorbidities2 4 and ethnicity5 as potentially important risk factors for susceptibility to infection, hospitalisation or death due to infection. In addition, chronic use of some medications at the time of exposure has been suggested as a potential risk factor for infection or severe adverse outcomes due to infection,6 although the evidence is currently too limited to confirm or refute these concerns.7 Understanding this chronic medication use is important because medications could be modified in individuals or at a populace scale to alter the likelihood of infection or adverse outcomes. Furthermore, associations between medications and improved results, if confirmed from large cohorts, could provide a basis for quick prioritisation in prospective randomised clinical tests, and might provide important insights into disease mechanisms and pathogenesis. SARS-CoV-1 and SARS-CoV-2, which have been responsible for the SARS epidemic and for the COVID-19 pandemic, respectively, interface with the renin-angiotensin-aldosterone system (RAAS) through ACE2, an enzyme that modulates the effects of the RAAS but is also the primary receptor for both SARS viruses. The connection between the SARS viruses and ACE2 may be one determinant of their infectivity, and you will find issues that RAAS inhibitors may switch ACE2 manifestation and hence COVID-19 virulence. This hypothesis has been extensively examined.7 ACE inhibitors and SB 431542 angiotensin receptor blocker (ARB) medicines are recommended from the National Institute for Health and Care Excellence as first-line treatment for individuals under 55 years of age with SB 431542 hypertension and second-line treatment for those over 55 years of age and for those of African descent.8 ACE inhibitors will also be widely used to treat congestive cardiac failure. Uncertainty around possible associations of these medicines with COVID-19 disease, and the subsequent risk that individuals might quit taking these medicines of verified performance, offers led to regulatory and professional body issuing statements urging individuals to keep taking their regular medications.9 Although several studies have considered the effect in hospitalised patients of drugs acting.