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

Abstract

Considerable concern has emerged for the potential harm in the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor inhibitors (ARBs) in COVID-19 patients, given that ACEIs and ARBs may increase the expression of ACE2 receptors that represent the way for coronavirus 2 to entry into the cell and cause severe acute respiratory syndrome. Assess the effect of ACEI/ARBs on outcome in COVID-19 patients. Hospital-based prospective study. A total of 431 patients consecutively presenting at the Emergency Department and found to be affected by COVID-19 were assessed. Relevant clinical and laboratory variables were recorded, focusing on the type of current anti hypertensive treatment. Outcome variables were NO, MILD, SEVERE respiratory distress (RD) operationally defined and DEATH. Hypertension was the single most frequent comorbidity (221/431 = 51%). Distribution of antihypertensive treatment was: ACEIs 77/221 (35%), ARBs 63/221 (28%), OTHER than ACEIs or ARBs 64/221 (29%). In 17/221 (8%) antihypertensive medication was unknown. The proportion of patients taking ACEIs, ARBs or OTHERs who developed MILD or SEVERE RD was 43/77 (56%), 33/53 (52%), 39/64 (61%) and 19/77 (25%), 16/63 (25%) and 16/64 (25%), respectively, with no statistical difference between groups. Despite producing a RR for SEVERE RD of 2.59 (95% CI 1.93-3.49), hypertension was no longer significant in a logistic regression analysis that identified age, CRP and creatinine as the sole independent predictors of SEVERE RD and DEATH. ACEIs and ARBs do not promote a more severe outcome of COVID-19. There is no reason why they should be withheld in affected patients.

A comprehensive guide to the pharmacologic regulation of angiotensin converting enzyme 2 (ACE2), the SARS-CoV-2 entry receptor

“…In recent months, several clinical studies have reported that the use of ARBs and ACE-Inhs. does not affect disease progression and mortality rates in COVID-19 patients ( Anzola et al, 2020 ; Bae et al, 2020 ; Braude et al, 2020 ; Cordeanu et al, 2020 ; H. Cui et al, 2020 ; Di Castelnuovo et al, 2020 ; Gormez et al, 2020 ; Hippisley-Cox et al, 2020 ; Kalra et al, 2020 ; Khan et al, 2020 , Kim et al, 2020 ; Kocayigit et al, 2020 ; Lafaurie et al, 2020 ; J. Lee et al, 2020 ; Sardu et al, 2020 ; Soleimani et al, 2020 , Taher et al, 2020 ; Trifirò et al, 2020 , Wang et al, 2020 ). Altogether, these results indicate that the use of ACE-Inhs.…”

The effects of hypertension on the prognosis of coronavirus disease 2019: a systematic review and meta-analysis on the interactions with age and antihypertensive treatment

“…A total of 7087 potentially relevant articles were identified by our searching strategy. After excluding 6001 unqualified articles, 86 articles were involved in the subsequent analysis [2,4–7,9,10,14–16,20–95]. Of these, 23 studies contained multiple endpoints with two more kinds of comparisons (Fig.…”

Furin Expression in Patients With Psoriasis—A Patient Cohort Endangered to SARS-COV2?

“…However, since ACE2 is commonly targeted in antihypertensive treatment as well, it has been hypothesized that those patients may also have an increased risk for severe infection, due to an upregulated ACE2 expression caused by its inhibitors ( 43 ). However, antihypertensive treatment has not been associated with respiratory distress or mortality in hospitalized patients, but it remains unknown if it increases the risk for hospitalization ( 44 ).…”