{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T07:47:27Z","timestamp":1777794447730,"version":"3.51.4"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T00:00:00Z","timestamp":1679616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01 HL152699"],"award-info":[{"award-number":["R01 HL152699"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities","doi-asserted-by":"publisher","award":["P50 MD017341"],"award-info":[{"award-number":["P50 MD017341"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,6,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In March and April 2020, medical societies published statements recommending continued use of renin\u2013angiotensin system (RAS) inhibitors despite theoretical concerns that these medications could increase COVID-19 severity. Determining if patients discontinued RAS inhibitors during the COVID-19 pandemic could inform responses to future public health emergencies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We analyzed claims data from US adults with health insurance in the Marketscan database. We identified patients who filled a RAS inhibitor and were persistent, defined by not having a \u226530-day gap without medication available, and high adherence, defined by having medication available on \u226580% of days, from March 2019 to February 2020. Among these patients, we estimated the proportion who discontinued their RAS inhibitor (i.e., had \u226530 consecutive days without a RAS inhibitor available to take) between March and August 2020. For comparison, we estimated the proportion of patients that discontinued a RAS inhibitor between March and August 2019 after being persistent with high adherence from March 2018 to February 2019.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 816,380 adults who were persistent and adherent to a RAS inhibitor from March 2019 to February 2020, 10.8% discontinued this medication between March and August 2020. Among 822,873 adults who were persistent and adherent to a RAS inhibitor from March 2018 to February 2019, 11.7% discontinued this medication between March and August 2019. The multivariable-adjusted relative risk for RAS inhibitor discontinuation in 2020 vs. 2019 was 0.94 (95% CI 0.93\u20130.95).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>There was no evidence of an increase in RAS inhibitor discontinuation during the early stage of the COVID-19 pandemic.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ajh\/hpad027","type":"journal-article","created":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T10:46:21Z","timestamp":1679654781000},"page":"404-410","source":"Crossref","is-referenced-by-count":3,"title":["Discontinuation of Renin\u2013Angiotensin System Inhibitors During the Early Stage of the COVID-19 Pandemic"],"prefix":"10.1093","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4711-5492","authenticated-orcid":false,"given":"Paul","family":"Muntner","sequence":"first","affiliation":[{"name":"Department of Epidemiology, University of Alabama at Birmingham , Birmingham, Alabama , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn","family":"Foti","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Alabama at Birmingham , Birmingham, Alabama , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhixin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Alabama at Birmingham , Birmingham, Alabama , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chibuike J","family":"Alanaeme","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Alabama at Birmingham , Birmingham, Alabama , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eunhee","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Columbia University Irving Medical Center , New York, New York , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam P","family":"Bress","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, University of Utah , Salt Lake City, Utah , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6302-8834","authenticated-orcid":false,"given":"Daichi","family":"Shimbo","sequence":"additional","affiliation":[{"name":"Department of Medicine, Columbia University Irving Medical Center , New York, New York , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"Kronish","sequence":"additional","affiliation":[{"name":"Department of Medicine, Columbia University Irving Medical Center , New York, New York , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,3,24]]},"reference":[{"key":"2023061507123060100_CIT0001","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1002\/ddr.21656","article-title":"Angiotensin receptor blockers as tentative SARS-CoV-2 therapeutics","volume":"81","author":"Gurwitz","year":"2020","journal-title":"Drug Dev Res"},{"key":"2023061507123060100_CIT0002","doi-asserted-by":"crossref","first-page":"1653","DOI":"10.1056\/NEJMsr2005760","article-title":"Renin-angiotensin-aldosterone system inhibitors in patients with Covid-19","volume":"382","author":"Vaduganathan","year":"2020","journal-title":"N Engl J Med"},{"key":"2023061507123060100_CIT0003","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1038\/nature02145","article-title":"Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus","volume":"426","author":"Li","year":"2003","journal-title":"Nature"},{"key":"2023061507123060100_CIT0004","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.cell.2020.02.052","article-title":"SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor","volume":"181","author":"Hoffmann","year":"2020","journal-title":"Cell"},{"key":"2023061507123060100_CIT0005","doi-asserted-by":"crossref","first-page":"2605","DOI":"10.1161\/CIRCULATIONAHA.104.510461","article-title":"Effect of angiotensin-converting enzyme inhibition and angiotensin II receptor blockers on cardiac angiotensin-converting enzyme 2","volume":"111","author":"Ferrario","year":"2005","journal-title":"Circulation"},{"key":"2023061507123060100_CIT0006","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.regpep.2010.09.005","article-title":"Telmisartan attenuates aortic hypertrophy in hypertensive rats by the modulation of ACE2 and profilin-1 expression","volume":"166","author":"Zhong","year":"2011","journal-title":"Regul Pept"},{"key":"2023061507123060100_CIT0007","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1161\/HYPERTENSIONAHA.119.14360","article-title":"Trends in antihypertensive medication monotherapy and combination use among US adults, National Health and Nutrition Examination Survey 2005\u20132016","volume":"75","author":"Derington","year":"2020","journal-title":"Hypertension"},{"key":"2023061507123060100_CIT0008","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1053\/j.ajkd.2015.10.011","article-title":"Renin-angiotensin system inhibitors and kidney and cardiovascular outcomes in patients with CKD: a Bayesian Network Meta-analysis of Randomized Clinical Trials","volume":"67","author":"Xie","year":"2016","journal-title":"Am J Kidney Dis"},{"key":"2023061507123060100_CIT0009","doi-asserted-by":"crossref","first-page":"2088","DOI":"10.1093\/eurheartj\/ehs075","article-title":"Angiotensin-converting enzyme inhibitors reduce mortality in hypertension: a meta-analysis of randomized clinical trials of renin-angiotensin-aldosterone system inhibitors involving 158,998 patients","volume":"33","author":"van Vark","year":"2012","journal-title":"Eur Heart J"},{"key":"2023061507123060100_CIT0010","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1056\/NEJM200001203420301","article-title":"Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients","volume":"342","author":"Yusuf","year":"2000","journal-title":"N Engl J Med"},{"key":"2023061507123060100_CIT0011","author":"Bozkurt","year":"2020"},{"key":"2023061507123060100_CIT0012","year":"2020"},{"key":"2023061507123060100_CIT0013","author":"De Simone","year":"2020"},{"key":"2023061507123060100_CIT0014","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/ajh\/hpaa057","article-title":"Hypertension and COVID-19","volume":"33","author":"Schiffrin","year":"2020","journal-title":"Am J Hypertens"},{"key":"2023061507123060100_CIT0015","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1002\/pds.5371","article-title":"Generalizability and accuracy of IBM MarketScan health risk assessment instrument data for augmentation of commercial claims data","volume":"31","author":"Albogami","year":"2022","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"2023061507123060100_CIT0016","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1161\/HYPERTENSIONAHA.116.07720","article-title":"Trends in antihypertensive medication discontinuation and low adherence among Medicare beneficiaries initiating treatment from 2007 to 2012","volume":"68","author":"Tajeu","year":"2016","journal-title":"Hypertension"},{"key":"2023061507123060100_CIT0017","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1161\/HYPERTENSIONAHA.118.12495","article-title":"Antihypertensive medication nonpersistence and low adherence for adults &lt;65 years initiating treatment in 2007\u20132014","volume":"74","author":"Tajeu","year":"2019","journal-title":"Hypertension"},{"key":"2023061507123060100_CIT0018","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1080\/08037051.2019.1627858","article-title":"Medication persistence to antihypertensive drug treatment\u2014a cross-sectional study of attitudes towards hypertension and medication in persistent and non-persistent patients","volume":"28","author":"Qvarnstrom","year":"2019","journal-title":"Blood Press"},{"key":"2023061507123060100_CIT0019","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1136\/amiajnl-2011-000151","article-title":"Improving the validity of determining medication adherence from electronic health record medications orders","volume":"18","author":"Carroll","year":"2011","journal-title":"J Am Med Inform Assoc"},{"key":"2023061507123060100_CIT0020","doi-asserted-by":"crossref","first-page":"S11","DOI":"10.1097\/MLR.0b013e31829b1d2a","article-title":"Standardizing terminology and definitions of medication adherence and persistence in research employing electronic databases","volume":"51","author":"Raebel","year":"2013","journal-title":"Med Care"},{"key":"2023061507123060100_CIT0021","doi-asserted-by":"crossref","first-page":"e006056","DOI":"10.1161\/JAHA.117.006056","article-title":"Antihypertensive medication adherence and risk of cardiovascular disease among older adults: a population-based cohort study","volume":"6","author":"Yang","year":"2017","journal-title":"J Am Heart Assoc"},{"key":"2023061507123060100_CIT0022","doi-asserted-by":"crossref","first-page":"2496","DOI":"10.1016\/j.jacc.2019.09.025","article-title":"Ischemic event rates in very-high-risk adults","volume":"74","author":"Colantonio","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2023061507123060100_CIT0023","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1161\/CIRCOUTCOMES.115.002524","article-title":"Short-term risk of serious fall injuries in older adults initiating and intensifying treatment with antihypertensive medication","volume":"9","author":"Shimbo","year":"2016","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"2023061507123060100_CIT0024","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical characteristics of coronavirus disease 2019 in China","volume":"382","author":"Guan","year":"2020","journal-title":"N Engl J Med"},{"key":"2023061507123060100_CIT0025","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/S0140-6736(20)30566-3","article-title":"Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study","volume":"395","author":"Zhou","year":"2020","journal-title":"Lancet"},{"key":"2023061507123060100_CIT0026","doi-asserted-by":"crossref","first-page":"m1091","DOI":"10.1136\/bmj.m1091","article-title":"Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study","volume":"368","author":"Chen","year":"2020","journal-title":"BMJ"},{"key":"2023061507123060100_CIT0027","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1002\/path.1570","article-title":"Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis","volume":"203","author":"Hamming","year":"2004","journal-title":"J Pathol"},{"key":"2023061507123060100_CIT0028","doi-asserted-by":"crossref","first-page":"14614","DOI":"10.1128\/JVI.79.23.14614-14621.2005","article-title":"ACE2 receptor expression and severe acute respiratory syndrome coronavirus infection depend on differentiation of human airway epithelia","volume":"79","author":"Jia","year":"2005","journal-title":"J Virol"},{"key":"2023061507123060100_CIT0029","doi-asserted-by":"crossref","first-page":"e019669","DOI":"10.1161\/JAHA.120.019669","article-title":"Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers use and COVID-19 infection among 824 650 patients with hypertension from a US integrated healthcare system","volume":"10","author":"An","year":"2021","journal-title":"J Am Heart Assoc"},{"key":"2023061507123060100_CIT0030","doi-asserted-by":"crossref","first-page":"1705","DOI":"10.1016\/S0140-6736(20)31030-8","article-title":"Use of renin-angiotensin-aldosterone system inhibitors and risk of COVID-19 requiring admission to hospital: a case-population study","volume":"395","author":"de Abajo","year":"2020","journal-title":"Lancet"},{"key":"2023061507123060100_CIT0031","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1001\/jama.2020.25864","article-title":"Effect of discontinuing vs continuing angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on days alive and out of the hospital in patients admitted with COVID-19: a randomized clinical trial","volume":"325","author":"Lopes","year":"2021","journal-title":"JAMA"},{"key":"2023061507123060100_CIT0032","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1016\/j.dsx.2020.06.047","article-title":"The use of renin angiotensin system inhibitor on mortality in patients with coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis","volume":"14","author":"Pranata","year":"2020","journal-title":"Diabetes Metab Syndr"},{"key":"2023061507123060100_CIT0033","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1093\/ajh\/hpac001","article-title":"Effects of renin-angiotensin system inhibitors on mortality and disease severity of COVID-19 patients: a meta-analysis of randomized controlled trials","volume":"35","author":"Yin","year":"2022","journal-title":"Am J Hypertens"}],"container-title":["American Journal of Hypertension"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajh\/advance-article-pdf\/doi\/10.1093\/ajh\/hpad027\/50084016\/hpad027.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajh\/article-pdf\/36\/7\/404\/50570732\/hpad027.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajh\/article-pdf\/36\/7\/404\/50570732\/hpad027.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,15]],"date-time":"2023-06-15T07:12:58Z","timestamp":1686813178000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajh\/article\/36\/7\/404\/7085517"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,24]]},"references-count":33,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,3,24]]},"published-print":{"date-parts":[[2023,6,15]]}},"URL":"https:\/\/doi.org\/10.1093\/ajh\/hpad027","relation":{},"ISSN":["0895-7061","1941-7225"],"issn-type":[{"value":"0895-7061","type":"print"},{"value":"1941-7225","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,7,1]]},"published":{"date-parts":[[2023,3,24]]}}}