(92) Initiation of Antihypertensive Drugs to Patients with Confirmed COVID-19 - a Population-Based Cohort Study in Sweden

Friday, August 26, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 423

Presenting Author(s)

Björn Wettermark, MscPharm, PhD
– Professor, Uppsala university, Uppsala, Sweden

Co-Author(s)

Salar Issa Moussa
– Faculty of Pharmacy, Uppsala university, Sweden, Sweden
Fredrik Nyberg, MD, PhD, FISPE
– Prof. of Register Epidemiology, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, M�lndal, V�stra G�talands l�n, Sweden
Mohammadhossein Hajiebrahimi
– Uppsala University, Uppsala, Uppsala l�n, Sweden
Rebecka Bertilsson
– National Diabetes Register, Centre of Registers Västra Götaland, Gothenburg, Sweden, Sweden
Jonatan Nåtman
– National Diabetes Register, Centre of Registers Västra Götaland, Gothenburg, Sweden, Sweden
Ailiana Santosa
– School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Sweden

Background: Hypertension is an important risk factor for severe outcomes in patients with COVID-19 and antihypertensive drugs may have a protective effect. However, the intensified focus on COVID-19 prevention and treatment, lockdown measures and physical distancing restrictions may have negatively impacted healthcare services for chronic diseases.

Objectives: To study initiations of different antihypertensive medicines to patients infected with Covid-19 compared with matched controls from the general population.

Methods: A cohort study was conducted for all Swedish residents 20-80 years old with a COVID-19-positive test compared to an unexposed group without COVID-19 matched for age, sex and index date (date of confirmed covid-19). Data were collected within SCIFI-PEARL, a study including linked data on Covid-tests, hospital diagnoses, dispensed prescription drugs and socioeconomic data from Swedish national registers. Initiations of different antihypertensive drug classes were studied from March 2020 until October 2020. Incidence rates were expressed per 1000 person-year (P-Y) for the exposed and unexposed group. Associations between initiation of antihypertensive medicine and risk of COVID-19 were assessed by a multivariable Cox proportional hazards model.

Results: A total of 224,582 patients (exposed and unexposed) were included. Betablockers were most common and initiated to 30.4 [28.3-32.6] patients per 1000 P-Y among the exposed and 16.9 [15.4- 18.5 ] patients per 1000 P-Y among the unexposed, respectively. After adjusting for cardiovascular comorbidities and education level, ACEi was the most commonly initiated antihypertensive agent to patients with COVID-19. Hazard ratio and 95% confidence interval for initiation of drug consumption was 1.83 [1.53-2.19] for ACEi, followed by beta-blockers 1.74 [1.55-1.95], calcium channel blockers 1.61 [1.41-1.83], angiotensin receptor blockers 1.61 [1.40-1.86] and diuretics 1.53 [1.32-1.77].

Conclusions: All antihypertensive medicines were initiated more frequently in COVID-19 patients. This can either be associated with hypertension caused by the COVID-19 infection, more frequent diagnosis of hypertension among people with COVID-19 since they consult healthcare, or residual confounding factors not adjusted for in the study.