Angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors usage is associated with improved inflammatory status and clinical outcomes in COVID …

G Yang, Z Tan, L Zhou, M Yang, L Peng, J Liu, J Cai… - MedRxiv, 2020 - medrxiv.org
G Yang, Z Tan, L Zhou, M Yang, L Peng, J Liu, J Cai, R Yang, J Han, Y Huang, S He
MedRxiv, 2020medrxiv.org
With the capability of inducing elevated expression of ACE2, the cellular receptor for SARS-
CoV-2, angiotensin II receptor blockers or angiotensin-converting enzyme inhibitors
(ARBs/ACEIs) treatment may have a controversial role in both facilitating virus infection and
reducing pathogenic inflammation. We aimed to evaluate the correlation of ARBs/ACEIs
usage with the pathogenesis of COVID-19 in a retrospective, single-center study. 126
COVID-19 patients with preexisting hypertension at Hubei Provincial Hospital of Traditional …
Abstract
With the capability of inducing elevated expression of ACE2, the cellular receptor for SARS-CoV-2, angiotensin II receptor blockers or angiotensin-converting enzyme inhibitors (ARBs/ACEIs) treatment may have a controversial role in both facilitating virus infection and reducing pathogenic inflammation. We aimed to evaluate the correlation of ARBs/ACEIs usage with the pathogenesis of COVID-19 in a retrospective, single-center study. 126 COVID-19 patients with preexisting hypertension at Hubei Provincial Hospital of Traditional Chinese Medicine (HPHTCM) in Wuhan from January 5 to February 22, 2020 were retrospectively allocated to ARBs/ACEIs group (n=43) and non-ARBs/ACEIs group (n=83) according to their antihypertensive medication. 125 age- and sex-matched COVID-19 patients without hypertension were randomly selected as non-hypertension controls. In addition, the medication history of 1942 hypertension patients that were admitted to HPHTCM from November 1 to December 31, 2019 before COVID-19 outbreak were also reviewed for external comparison. Epidemiological, demographic, clinical and laboratory data were collected, analyzed and compared between these groups. The frequency of ARBs/ACEIs usage in hypertension patients with or without COVID-19 were comparable. Among COVID-19 patients with hypertension, those received either ARBs/ACEIs or non-ARBs/ACEIs had comparable blood pressure. However, ARBs/ACEIs group had significantly lower concentrations of CRP (p=0.049) and procalcitonin (PCT, p=0.008). Furthermore, much lower proportion of critical patients (9.3% vs 22.9%; p=0.061), and a lower death rate (4.7% vs 13.3%; p=0.216) were observed in ARBs/ACEIs group than non-ARBs/ACEIs group, although these differences failed to reach statistical significance. Our findings thus support the use of ARBs/ACEIs in COVID-19 patients with preexisting hypertension.
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