Trends in Angiotensin Receptor Blocker Use Among those at Risk for COVID-19 Morbidity and Mortality in the United States

  1. Alexandra Perez
  2. Robert Speth
  3. Juan Saavedra

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Abstract

Importance

Assessment of the use of angiotensin receptor blockers (ARBs) in the United States provides insight into prescribing practices, and may inform guidelines, policy measures and research during the COVID-19 pandemic.

Objective

To evaluate trends in ARB use among adults in the United States who have preexisting conditions and sociodemographic risk factors that put them at a higher risk of SARS-CoV-2 infection and COVID-19-related complications and mortality.

Design, setting and participants

This study uses the nationally representative cross-sectional data from the 2005-2018 National Health and Nutrition Examination Survey (NHANES). Participants included 39,749 non-institutionalized U.S. civilian adults who were 20 years and older and those with the most common preexisting conditions and risk factors reported among patients with COVID-19.

Main outcomes and measures

Use of ARBs in the prior 30 days from survey interview.

Results

ARB use ranged from 7.4% [95% CI, 6.5%-8.4%] to 26.2% [95% CI, 19.4%-34.4%] among those with one or two metabolic, renal, respiratory, and/or cardiovascular diseases. Among individuals with the three most common preexisting conditions in patients with COVID-19 including hypertension, diabetes and obesity, ARB use was higher among the elderly, females, non-Hispanic whites, and those with health insurance coverage.

Conclusions and relevance

In this nationally representative survey, ARB use was found to be widespread, but unevenly distributed among individuals with conditions and sociodemographic risk factors that place them at a higher risk of COVID-19 morbidity and mortality.

Key Points

Question

What is the prevalence of angiotensin receptor blocker (ARB) use among individuals at higher risk of COVID-19-related complications?

Findings

In a cross-sectional study with data from 39,749 adult participants of the National Health and Nutrition Examination Survey, ARB use ranged between 7.4% and 26.2% among those with one or two respiratory, metabolic, renal and/or cardiovascular diseases. Significant disparities in ARB use were found in participants with preexisting conditions and sociodemographic factors that place them at a higher risk of COVID-19 morbidity and mortality.

Meaning

ARB use is widespread and disproportionate in the United States among people at higher risk of COVID-19 complications.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2020.07.24.20161851: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This study used publicly available, deidentified data and did not require institutional review board approval (45 CFR§46.102(f)).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All analyses were conducted using IBM SPSS version 26.0.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has several limitations: 1) since survey participants were non-institutionalized civilians, the study results may not be extrapolated to those living in nursing homes or incarcerated individuals where COVID-19 has been prevalent and should only be generalized to the community-dwelling US adult population; 2) diagnoses of the comorbidities and medication use presented here are based on self-report and may be subject to error due to recall bias; and 3) this study does not address the use of single ARB therapy compared with the use of ARBs combined with additional antihypertensive drugs or compliance to treatment. Evaluation of the use of ARBs among the highly affected Native American population was not possible in this study. In conclusion, our report will inform both clinical practice and research, and will be useful in prioritizing future studies on whether ARB use influences SARS-CoV-2 infection rates, the development of symptoms, the severity of the illness, the prognosis of COVID-19, and the process of recovery in the subpopulations evaluated here.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.07.24.20161851v1 on medRxiv