Prescribing pattern for anti-hypertensive medicines in patients with confirmed Covid-19 :  A population based cohort study in Sweden

Sammanfattning: Background: Covid-19 infection caused by SARS-Cov-2 virus came to light at the end of 2019 and was declared as a pandemic by WHO in March 2020. Many comorbidities have shown to be associated with the severity of the viral infection with hypertension being one of the highest rated comorbidities since loss of the ACE2 receptor due to SARS-Cov-2 infection can lead to increased blood pressure. However, there is limited research on the prescribing of different antihypertensives in patients with covid-19. Aim: to study the initiation of different antihypertensive medicines for the patients whom had the Covid-19 infection. Materials and Method: Data were collected from a data base called SCIFI-PEARL based on linked data on covid-tests, diagnoses, dispensed prescription drugs and socioeconomic data from a number Swedish national registers. A cohort study was conducted for subjects between 20-80 years old with a Covid-19 positive tests compared to controls matched for age, sex and index point. Initiations of different antihypertensive drug classes were studied until October 2020 when the data were lastly collected. Results: A total of 224582 patients (both exposed and controls) were included in the study. After adjusting for comorbidities, ACEi was most commonly initiated to patients with covid-19 Hazard Ratio compared to controls being 1.83 [1.53, 2.19], followed by betablockers 1.74 [1.55, 1.95], CCBs 1.61 [1.41, 1.83], ARBs 1.61 [1.40, 1.86] and Diuretics 1.53 [1.32, 1.77]. There were no significant differences in initiations of ACEi and ARBs with fixed combination with Diuretics in Covid-19 infected patients compared to controls. Conclusion: All studied antihypertensive medicines were initiated more frequently to patients with Covid-19. This can either be associated with hypertension related to the Covid-19 infection or residual confounding factors not matched or adjusted for in the study.