In a population of almost 2 million hypertensive patients (ACE inhibitors: 566?023; ARB: 958?227; CCB: 358?306) followed for 16 weeks, 2338 were hospitalized and 526 died or were intubated for COVID-19. a population of almost 2 million hypertensive patients (ACE inhibitors: 566?023; ARB: 958?227; CCB: 358?306) followed for 16 weeks, 2338 were hospitalized and 526 died or were intubated for COVID-19. ACE inhibitors and ARBs were associated with a lower risk of COVID-19 hospitalization compared with CCBs (hazard ratio, 0.74 [95% CI, 0.65C0.83] and 0.84 [0.76C0.93], respectively) and a lower risk of intubation/death. Risks were slightly lower for ACE inhibitor users MI-3 than for ARB users. This large observational study may suggest a lower COVID-19 risk in hypertensive patients treated over a long period with ACE inhibitors or ARBs compared with CCBs. These results, if confirmed, tend to contradict previous hypotheses and raise new hypotheses. and type of medical or surgical procedures coded according to the French common classification of medical procedures (axis adjusted to account for rare events. ACE indicates angiotensin-converting enzyme and ACEI, ACE inhibitors; ARB, angiotensin receptor blockers; and CCB, calcium channel blockers. Open in a separate window Figure 3. Kaplan-Meier survival curves of time to hospitalization for coronavirus disease 2019 (COVID-19) death or intubation stratified by treatment group and showing the proportion of subjects MI-3 with no event from the index date (February 15, 2020) MI-3 until the end of follow-up. axis adjusted to account for rare events. ACE indicates angiotensin-converting enzyme and ACEI, ACE inhibitors; ARB, angiotensin receptor blockers; and CCB, calcium channel blockers. In the main analysis with inverse probability of treatment weighting, ACE inhibitors, and ARB exposures were associated with a decreased risk of hospitalization with COVID-19 compared with exposure to CCB (HR, 0.74 [95% CI, 0.65C0.83] 0.84 [95% CI, 0.76C0.93], respectively). ACE inhibitors and ARB exposures were also associated with a decreased risk of intubation or death in the main analysis compared with CCB exposure (HR, 0.66 [95% CI, 0.51C0.84]; 0.79 [95% CI, 0.64C0.98], respectively). We observed a lower risk for hospitalization (HR, 0.87 [95% CI, 0.79C0.96]) and death or intubation (HR, 0.83 [95% CI, 0.67C1.03]) in patients in the ACE inhibitors group compared with patients in the ARB group (data not shown). Additional multivariable analyses yielded similar results. The negative associations between ARB and ACE inhibitors exposures and hospitalization for COVID-19 compared with exposure to CCB were observed in almost all subgroups according to sex, age, whether the region was among the regions most severely affected by COVID-19, or whether individuals were reimbursed for other antihypertensive drugs (Table ?(Table3).3). The association tended to be more pronounced in individuals aged 51 to 60 years (HR, 0.65 [95% CI, 0.51C0.82] for ACE inhibitors versus CCB; HR, 0.76 [95% CI, 0.61C0.94] for ARB versus CCB), in the regions most severely affected by COVID-19 (HR, 0.65 [95% CI, 0.57C0.74] and 0.79 [0.71C0.89]) and for death/intubation outcomes only, when patients did not take any other antihypertensive drug (HR, 0.59 [95% CI, 0.43C0.80] and 0.69 [0.53C0.89], respectively). Results were still consistent after exclusion of patients (Table S6) with cancer, after excluding MI-3 patients who switched treatment to one of the other 2 drug classes or who stopped treatment during the 3 months following the index date, and after excluding patients reimbursed for anticoagulants, heparin, or antiplatelet drugs (n=17?080 [3%], 26?100 [3%], 10?779 [3%] in the ACE inhibitors, ARB, and CCB cohorts, respectively). In the later analysis, HRs of ACE inhibitors and ARB exposures for the risk of hospitalization with COVID-19 compared with CCB were 0.74 (95% CI, 0.65C0.83) UKp68 and 0.84 (95% CI, 0.76C0.93), respectively. Table 3. Association Between Exposure to Antihypertensive Drugs (CCB, ACE Inhibitors, MI-3 ARB) and Risk of 2 COVID-19 Outcomes (Hospitalization and Death or Intubation for COVID-19) in a Multivariable Cox Model With Inverse Probability of.