Antihypertensive drugs and risk of COVID-19? – Authors' reply

Abstract

Antihypertensive drugs and risk of COVID-19? Authors' replyWe thank Joshua Brown, Kevin Lo and colleagues, and Christopher Tignanelli and colleagues for their responses to our Correspondence 1 , and we welcome the opportunity to reply.The fast-developing pandemic of corona virus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported from Wuhan, China, 2 and has spread globally. As of March 22, 2020, 307 297 people have been infected by SARS-CoV-2, with 13 049 deaths and 92 382 people recovered. Several reports have summarised the clinical and epidemiological features of COVID-19 and have shown specific comorbidities associated with increased risk of infection and developing into a severe or fatal case. Of 1099 infected patients, 173 had severe disease, in whom the most common comorbidities were hypertension (24%), diabetes (16%), coronary heart disease (6%), and cerebrovascular disease (2%). 3 In a second cohort of 41 patients hospitalised with COVID-19, 4 diabetes (20%), hypertension (15%), and cardiovascular disease (15%) were frequent comorbidities. Among 191 patients hospitalised with COVID-19, 5 the most common comorbidities with significant effects on mortality were hypertension (30%; p=0•0008), diabetes (36%; p=0•0051), and coronary heart disease (15%; p=0•0001). In an analysis of 201 patients with COVID-19, 6 84 (42%) patients developed acute respiratory distress syndrome, with hypertension (27%) and diabetes (19%) as the most common comorbidities.Hypertension, diabetes, and cardiovascular disease, which seem to be the most common comorbidities in patients with COVID-19, are typically treated with drugs that inhibit the renin-angiotensin system (RAS), including angiotensin-converting

Neither ACEIs nor ARBs are associated with respiratory distress or mortality in COVID-19 results of a prospective study on a hospital-based cohort

“…Moreover, in univariate analyses hypertensive patients appear to be more likely to develop acute respiratory distress syndrome [5,8], to be admitted in intensive care units [1,8] or to die [1,3,5], although this effect may become no more significant when corrected by age [3,14]. From many authorities, it has been suggested that taking ACEIs or ARBs may amplify the expression of ACE2 receptors that represent the way for SARS-CoV-2 to entry the respiratory cells and are widely represented in the alveolar cells, thus promoting the spreading of viral particles from upper to lower respiratory tract [6][7][8][9][10][16][17][18]. However, the evidence for an increased activation of ACE2 from ACEIs and ARBs is far from being conclusive and moreover it may differ according to organ and ACEI type [6].…”

Identification of pulmonary comorbid diseases network based repurposing effective drugs for COVID-19

“…Use of these ACEIs found to be increased ACE2 levels in human intestine luminal cells and the ACE2 expression highly correlated with COVID-19 virulence 33 . Lei Fang et al, questioned the use of ACEIs to treat COVID-19 patient"s severity 34 . In this context, understanding different comorbidities of COVID-19 is essential for the frontline workers to decide about the mode of treatment strategies in advance.…”

Could DIZE be the answer to COVID-19?

“…A new strain of coronavirus identified as SARS-CoV-2 causes coronavirus disease-19 (COVID- 19) and appeared late in 2019. The World Health Organization (WHO) classified COVID-19 as a public health emergency on 30 January 2020.…”

“…Indeed SARS-Cov-2 virus has a higher affinity to ACE2 than SARS-CoV-1 [16]. Recently, opinions based on no evidence have been published suggesting that medications increasing ACE2 activity might worsen outcomes [17], and that patients on ARBs or ACE inhibitors pose a theoretical risk for worsened disease [18], and recently the authors have maintained their opinion [19] even after a counterargument [20]. Yet, if true, this opinion would disregard all the scientific data showing a benefit for ACE2 in pathologies.…”