{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T21:23:37Z","timestamp":1772745817355,"version":"3.50.1"},"posted":{"date-parts":[[2020,7,7]]},"group-title":"Infectious Diseases (except HIV\/AIDS)","reference-count":22,"publisher":"openRxiv","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2020,7,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:p>There are plausible mechanisms by which angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may increase the risk of COVID-19 infection or affect disease severity. To examine the association between these medications and COVID-19 infection or hospitalization, we conducted a retrospective cohort study within a US integrated healthcare system. Among people aged \u226518 years enrolled in the health plan for at least 4 months as of 2\/29\/2020, current ACEI and ARB use was identified from pharmacy data, and the estimated daily dose was calculated and standardized across medications. COVID-19 infections were identified through 6\/14\/2020 from laboratory and hospitalization data. We used logistic regression to estimate adjusted odds ratios (ORs) and 95% confidence intervals. Among 322,044 individuals, 720 developed COVID-19 infection. Among people using ACEI\/ARBs, 183\/56,105 developed COVID-19 (3.3 per 1000 individuals) compared with 537\/265,939 without ACEI\/ARB use (2.0 per 1000), yielding an adjusted OR of 0.94 (95% CI 0.75-1.16). For use of &lt; 1 defined daily dose vs. nonuse, the adjusted OR for infection was 0.89 (95% CI 0.62-1.26); for 1 to &lt; 2 defined daily doses, 0.97 (95% CI 0.71-1.31); and for \u22652 defined daily doses, 0.94 (95% CI 0.72-1.23). The OR was similar for ACEIs and ARBs and in subgroups by age and sex. 29% of people with COVID-19 infection were hospitalized; the adjusted OR for hospitalization in relation to ACEI\/ARB use was 0.92 (95% CI 0.54-1.57), and there was no association with dose. These findings support current recommendations that individuals on these medications continue their use.<\/jats:p>","DOI":"10.1101\/2020.07.06.20120386","type":"posted-content","created":{"date-parts":[[2020,7,7]],"date-time":"2020-07-07T18:55:11Z","timestamp":1594148111000},"source":"Crossref","is-referenced-by-count":8,"title":["Renin-angiotensin-aldosterone system inhibitors and COVID-19 infection or hospitalization: a cohort study"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6649-3659","authenticated-orcid":false,"given":"Sascha","family":"Dublin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rod","family":"Walker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James S.","family":"Floyd","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan M.","family":"Shortreed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharon","family":"Fuller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ladia","family":"Albertson-Junkans","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura B.","family":"Harrington","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mikael Anne","family":"Greenwood-Hickman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beverly B.","family":"Green","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruce M.","family":"Psaty","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"issue":"4","key":"2021011105351177000_2020.07.06.20120386v1.1","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 2005-2016","volume":"75","year":"2020","journal-title":"Hypertension"},{"key":"2021011105351177000_2020.07.06.20120386v1.2","doi-asserted-by":"publisher","DOI":"10.1056\/nejmsr2005760"},{"key":"2021011105351177000_2020.07.06.20120386v1.3","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-020-2012-7"},{"key":"2021011105351177000_2020.07.06.20120386v1.4","unstructured":"HFSA\/ACC\/AHA Statement Addresses Concerns Re: Using RAAS Antagonists in COVID-19 [press release]. 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