BACKGROUND There is concern about the potential of an increased risk related to medications that act on the renin-angiotensin-aldosterone system in patients exposed to coronavirus disease 2019 (Covid-19), because the viral receptor is angiotensin-converting enzyme 2 (ACE2). METHODS We assessed the relation between previous treatment with ACE inhibitors, angiotensin-receptor blockers, beta-blockers, calcium-channel blockers, or thiazide diuretics and the likelihood of a positive or negative result on Covid-19 testing as well as the likelihood of severe illness (defined as intensive care, mechanical ventilation, or death) among patients who tested positive. Using Bayesian methods, we compared outcomes in patients who had been treated with these medications and in untreated patients, overall and in those with hypertension, after propensity-score matching for receipt of each medication class. A difference of at least 10 percentage points was prespecified as a substantial difference. RESULTS Among 12,594 patients who were tested for Covid-19, a total of 5894 (46.8%) were positive; 1002 of these patients (17.0%) had severe illness. A history of hypertension was present in 4357 patients (34.6%), among whom 2573 (59.1%) had a positive test; 634 of these patients (24.6%) had severe illness. There was no association between any single medication class and an increased likelihood of a positive test. None of the medications examined was associated with a substantial increase in the risk of severe illness among patients who tested positive. CONCLUSIONS We found no substantial increase in the likelihood of a positive test for Covid-19 or in the risk of severe Covid-19 among patients who tested positive in association with five common classes of antihypertensive medications.

中文翻译：

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肾素-血管紧张素-醛固酮系统抑制剂和Covid-19的风险。

背景技术由于病毒受体是血管紧张素转化酶2（ACE2），因此暴露于冠状病毒病2019（Covid-19）的患者中与作用于肾素-血管紧张素-醛固酮系统的药物有关的风险增加的可能性令人担忧。方法我们评估了先前使用ACE抑制剂，血管紧张素受体阻滞剂，β受体阻滞剂，钙通道阻滞剂或噻嗪类利尿剂进行的治疗与Covid-19检测呈阳性或阴性结果的可能性之间的关系，以及严重的可能性之间的关系。呈阳性的患者的疾病（定义为重症监护，机械通气或死亡）。使用贝叶斯方法，我们比较了接受过这些药物治疗的患者和未经治疗的患者（整体）和高血压患者的结局，倾向得分匹配后，每种药物都将收到。预先规定至少有10个百分点的差异是实质性差异。结果在接受Covid-19检测的12,594例患者中，共有5894例（46.8％）为阳性。这些患者中有1002名（17.0％）患有严重疾病。4357例患者（34.6％）有高血压病史，其中2573例（59.1％）呈阳性。这些患者中有634名（24.6％）有重病。在任何单一药物类别和阳性试验可能性增加之间均无关联。在检测为阳性的患者中，没有一种药物与严重疾病风险的大幅增加相关。