Table 2.
Main and subgroup analyses for the association between use of renin–angiotensin–system inhibitors and mineralocorticoid receptor antagonists and outcomes
| Outcome/subgroup | Risk of hospitalization/ death for COVID‐19 in the overall population | Risk of all‐cause death in patients with COVID‐19 | ||||||
|---|---|---|---|---|---|---|---|---|
| ACEi/ ARB No | ACEi/ ARB Yes | MRA No | MRA Yes | ACEi/ ARB No | ACEi/ ARB Yes | MRA No | MRA Yes | |
| All patients | ||||||||
|
n (%) events b Event rate (95% CI) as PY c |
3237 (0.59) | 3909 (0.47) | 6580 (0.50) | 566 (0.70) | 8.5 (8.1–8.9) | 6.1 (5.8–6.4) | 7.0 (6.8–7.3) | 8.2 (7.3–9.3) |
| Crude OR b /HR c (95% CI) | Ref. | 0.79 (0.75–0.83) a | Ref. | 1.39 (1.28–1.52) a | Ref. | 0.76 (0.71–0.81) a | Ref. | 1.11 (0.98–1.26) |
| Adjusted (individual variables) OR b /HR c (95% CI) | Ref. | 0.86 (0.82–0.91) a | Ref. | 0.98 (0.90–1.08) | Ref. | 0.90 (0.83–0.97) a | Ref. | 0.96 (0.84–1.09) |
| Adjusted (IPW) OR/HR c (95% CI) | Ref. | 0.86 (0.81–0.91) a | Ref. | 0.97 (0.87–1.08) | Ref. | 0.89 (0.82–0.96) a | Ref. | 0.97 (0.84–1.12) |
| Patients with HF | ||||||||
|
n (%) events b Event rate (95% CI) as PY c |
766 (1.32) | 1192 (0.93) | 1563 (1.11) | 395 (0.88) | 13.1 (12.0–14.3) | 9.6 (8.9–10.4) | 11.2 (10.5–11.9) | 9.6 (8.4–11.0) |
| Crude OR b /HR c (95% CI) | Ref. | 0.70 (0.64–0.77) a | Ref. | 0.80 (0.71–0.89) a | Ref. | 0.77 (0.68–0.86) a | Ref. | 0.89 (0.77–1.03) |
| Adjusted (individual variables) OR b /HR c (95% CI) | Ref. | 0.90 (0.81–1.00) a | Ref. | 0.93 (0.83–1.04) | Ref. | 0.87 (0.77–0.99) a | Ref. | 0.94 (0.80–1.10) |
| Adjusted (IPW) OR/HR c (95% CI) | Ref. | 0.88 (0.79–0.98) a | Ref. | 0.91 (0.80–1.03) | Ref. | 0.86 (0.75–0.98) a | Ref. | 0.98 (0.83–1.15) |
| Patients with hypertension | ||||||||
|
n (%) events b Event rate (95% CI) as PY c |
2467 (0.67) | 3502 (0.47) | 5467 (0.53) | 502 (0.73) | 9.8 (9.3–10.4) | 6.3 (6.0–6.6) | 7.5 (7.2–7.8) | 7.9 (7.0–9.0) |
| Crude OR b /HR c (95% CI) | Ref. | 0.70 (0.67–0.74) a | Ref. | 1.40 (1.27–1.53) a | Ref. | 0.71 (0.66–0.76) a | Ref. | 1.02 (0.89–1.16) |
| Adjusted (individual variables) OR b /HR c (95% CI) | Ref. | 0.84 (0.79–0.89) a | Ref. | 0.99 (0.90–1.10) | Ref. | 0.89 (0.82–0.97) a | Ref. | 0.93 (0.80–1.07) |
| Adjusted (IPW) OR/HR c (95% CI) | Ref. | 0.84 (0.79–0.89) a | Ref. | 0.98 (0.87–1.09) | Ref. | 0.88 (0.81–0.96) a | Ref. | 0.95 (0.81–1.11) |
| Patients with renal disease | ||||||||
|
n (%) events b Event rate (95% CI) as PY c |
711 (1.27) | 711 (1.19) | 1277 (1.21) | 145 (1.40) | 10.7 (9.7–11.8) | 8.1 (7.2–8.9) | 9.3 (8.7–10.1) | 8.7 (6.9–11.0) |
| Crude OR b /HR c (95% CI) | Ref. | 0.94 (0.84–1.04) | Ref. | 1.15 (0.97–1.37) | Ref. | 0.78 (0.67–0.90) a | Ref. | 0.90 (0.71–1.14) |
| Adjusted (individual variables) OR b /HR c (95% CI) | Ref. | 0.90 (0.80–1.01) | Ref. | 0.91 (0.75–1.09) | Ref. | 0.91 (0.78–1.07) | Ref. | 0.91 (0.69–1.20) |
| Adjusted (IPW) OR/HR c (95% CI) | Ref. | 0.90 (0.80–1.01) | Ref. | 0.76 (0.61–0.93) a | Ref. | 0.88 (0.75–1.04) | Ref. | 1.01 (0.76–1.35) |
| Patients with IHD | ||||||||
|
n (%) events b Event rate (95% CI) as PY c |
1076 (0.74) | 1409 (0.58) | 2215 (0.63) | 270 (0.84) | 9.9 (9.1–10.7) | 7.1 (6.6–7.7) | 8.1 (7.6–8.6) | 9.6 (8.1–11.3) |
| Crude OR b /HR c (95% CI) | Ref. | 0.78 (0.72–0.85) a | Ref. | 1.34 (1.18–1.52) a | Ref. | 0.75 (0.68–0.84) a | Ref. | 1.09 (0.91–1.29) |
| Adjusted (individual variables) OR b /HR c (95% CI) | Ref. | 0.84 (0.77–0.92) a | Ref. | 0.96 (0.84–1.11) | Ref. | 0.88 (0.78–1.00) a | Ref. | 1.09 (0.91–1.32) |
| Adjusted (IPW) OR/HR c (95% CI) | Ref. | 0.83 (0.76–0.91) a | Ref. | 0.92 (0.79–1.08) | Ref. | 0.86 (0.75–0.98) a | Ref. | 1.09 (0.89–1.33) |
| Patients with diabetes | ||||||||
|
n (%) events b Event rate (95% CI) as PY c |
1093 (0.67) | 1599 (0.68) | 2454 (0.66) | 238 (0.98) | 6.8 (6.2–7.4) | 5.7 (5.2–6.1) | 6.0 (5.6–6.4) | 7.3 (6.0–8.8) |
| Crude OR b /HR c (95% CI) | Ref. | 1.02 (0.94–1.10) | Ref. | 1.49 (1.30–1.70) a | Ref. | 0.84 (0.75–0.95) a | Ref. | 1.09 (0.89–1.33) |
| Adjusted (individual variables) OR b /HR c (95% CI) | Ref. | 0.93 (0.85–1.01) | Ref. | 1.00 (0.86–1.16) | Ref. | 0.89 (0.78–1.02) | Ref. | 0.91 (0.73–1.14) |
| Adjusted (IPW) OR/HR c (95% CI) | Ref. | 0.92 (0.84–1.01) | Ref. | 0.96 (0.81–1.13) | Ref. | 0.86 (0.75–0.98) a | Ref. | 0.93 (0.73–1.19) |
| Patients in Stockholm region | ||||||||
|
n (%) events b Event rate (95% CI) as PY c |
1506 (1.40) | 1733 (1.10) | 3030 (1.20) | 209 (1.61) | 8.3 (7.7–8.9) | 5.4 (5.0–5.8) | 6.7 (6.3–7.0) | 5.8 (4.7–7.1) |
| Crude OR b /HR c (95% CI) | Ref. | 0.79 (0.73–0.84) a | Ref. | 1.35 (1.17–1.55) a | Ref. | 0.71 (0.64–0.78) a | Ref. | 0.89 (0.72–1.10) |
| Adjusted (individual variables) OR b /HR c (95% CI) | Ref. | 0.84 (0.78–0.91) a | Ref. | 0.89 (0.77–1.04) | Ref. | 0.87 (0.78–0.98) a | Ref. | 0.80 (0.63–1.00) |
| Adjusted (IPW) OR/HR c (95% CI) | Ref. | 0.83 (0.76–0.90) a | Ref. | 0.83 (0.70–0.98) a | Ref. | 0.85 (0.76–0.96) a | Ref. | 0.83 (0.65–1.06) |
ACEi, angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; CI, confidence interval; COVID‐19, coronavirus disease 2019; HF, heart failure; HR, hazard ratio; IHD, ischaemic heart disease; IPW, inverse probability weighting; MRA, mineralocorticoid receptor antagonist; OR, odds ratio; PY, patient‐years.
P <0.05.
Estimates provided for the analyses assessing the risk of hospitalization/death for COVID‐19 in the overall population.
Estimates provided for the analysis assessing the risk of all‐cause death in patients with COVID‐19.