BACKGROUND Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are known to impact the functional receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The association between chronic therapy with these medications and infection risk remains unclear. OBJECTIVES The objective was to determine the association between prior ACEI or ARB therapy and SARS-CoV-2 infection among patients with hypertension in the U.S. Veteran's Affairs health system. METHODS We compared the odds of SARS-CoV-2 infection among three groups: patients treated with ACEI, treated with ARB, or treated with alternate first-line anti-hypertensives without ACEI/ARB. We excluded patients with alternate indications for ACEI or ARB therapy. We performed an augmented inverse propensity weighted analysis with adjustment for demographics, region, comorbidities, vitals, and laboratory values. RESULTS Among 1,724,723 patients with treated hypertension, 659,180 were treated with ACEI, 310,651 with ARB, and 754,892 with neither. Before weighting, patients treated with ACEI or ARB were more likely to be diabetic and use more anti-hypertensives. There were 13,278 SARS-CoV-2 infections (0.8%) between February 12, 2020 and August 19, 2020. Patients treated with ACEI had lower odds of SARS-CoV-2 infection (odds ratio [OR] 0.93; 95% CI: 0.89-0.97) while those treated with ARB had similar odds (OR 1.02; 95% CI: 0.96-1.07) compared with patients treated with alternate first-line anti-hypertensives without ACEI/ARB. In falsification analyses, patients on ACEI did not have a difference in their odds of unrelated outcomes. CONCLUSIONS Our results suggest the safety of continuing ACEI and ARB therapy. The association between ACEI therapy and lower odds of SARS-CoV-2 infection requires further investigation.

中文翻译：

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肾素-血管紧张素-醛固酮系统抑制剂和 SARS-CoV-2 感染：来自退伍军人事务医疗保健系统的分析。

背景已知血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）会影响严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的功能受体。这些药物的长期治疗与感染风险之间的关系仍不清楚。目的 目的是确定美国退伍军人事务卫生系统中高血压患者既往接受过 ACEI 或 ARB 治疗与 SARS-CoV-2 感染之间的关联。方法 我们比较了三组患者感染 SARS-CoV-2 的几率：接受 ACEI 治疗、接受 ARB 治疗或接受替代一线抗高血压药物但不接受​​ ACEI/ARB 治疗的患者。我们排除了具有 ACEI 或 ARB 治疗替代适应症的患者。我们进行了增强逆倾向加权分析，并对人口统计、地区、合并症、生命体征和实验室值进行了调整。结果 在 1,724,723 名接受治疗的高血压患者中，659,180 名接受 ACEI 治疗，310,651 名接受 ARB 治疗，754,892 名未接受任何治疗。在加权之前，接受 ACEI 或 ARB 治疗的患者更有可能患有糖尿病，并使用更多的抗高血压药物。2020 年 2 月 12 日至 2020 年 8 月 19 日期间，共有 13,278 例 SARS-CoV-2 感染 (0.8%)。接受 ACEI 治疗的患者感染 SARS-CoV-2 的几率较低（比值比 [OR] 0.93；95% CI： 0.89-0.97），而接受 ARB 治疗的患者与接受替代一线抗高血压药物（不使用 ACEI/ARB）治疗的患者相比，其几率相似（OR 1.02；95% CI：0.96-1.07）。在证伪分析中，接受 ACEI 的患者发生不相关结果的几率没有差异。结论 我们的结果表明持续 ACEI 和 ARB 治疗的安全性。ACEI 治疗与降低 SARS-CoV-2 感染几率之间的关联需要进一步研究。