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.

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.