Renin-angiotensin system inhibitors improve the clinical outcomes of COVID-19 patients with hypertension

Meng, Juan; Gao, Xiao; Zhang, Juanjuan; He, Xing; Ou, Min; Bi, Jing; Yang, Rongqing; Di, Wencheng; Wang, Zhaoqin; Li, Zigang; Gao, Hong; Liu, Lei; Zhang, Guoliang

doi:10.1080/22221751.2020.1746200

Cited by 572 publications

(626 citation statements)

References 13 publications

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“…Those data are in agreement with recent evidence suggesting beneficial effects of anti-IL-6 receptor human antibody Tocilizumab for the treatment of SARS-CoV-2-induced ARDS [42]. Moreover, a recent study has shown that Coronavirus disease (COVID-19) patients with hypertension treated with ACE inhibitors and AT1R blockers had different values of viral load and an attenuation of the inflammatory response, likely through the inhibition of IL-6 levels [43].…”

Section: Ras and Acute Lung Injurysupporting

confidence: 91%

COVID-19 and RAS: Unravelling an Unclear Relationship

D’Ardes

Boccatonda

Rossi

et al. 2020

IJMS

101

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The renin-angiotensin system (RAS) plays a main role in regulating blood pressure and electrolyte and liquid balance. Previous evidence suggests that RAS may represent an important target for the treatment of lung pathologies, especially for acute respiratory distress syndrome and chronic fibrotic disease. The scientific community has recently focused its attention on angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor 1 (AT1R) inhibitors and their possible benefit/harms for patients infected by Coronavirus disease (COVID-19) who experience pneumonia, but there are still some doubts about the effects of these drugs in this setting.

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Section: Ras and Acute Lung Injurysupporting

confidence: 91%

COVID-19 and RAS: Unravelling an Unclear Relationship

D’Ardes

Boccatonda

Rossi

et al. 2020

IJMS

101

View full text Add to dashboard Cite

show abstract

“…At first glance, it is also reasonable to hypothesize that COVID-19 patients under previous ARB treatment for comorbid diseases may benefit from the continuation of this therapy, and that their symptoms may be moderated. Recent reports demonstrated that continuation of previous ARB therapy decreased morbidity and mortality in COVID-19 patients (Liu et al 2020a;Meng et al 2020), supporting this hypothesis. However, more controlled studies including thousands of patients are needed to reach a definite conclusion not only on the safety but also on the benefit of the continuation of established ARB therapy during COVID-19.…”

Section: Potential For Arbs To Modulate Covid-19 Pathophysiologymentioning

confidence: 65%

“…Furthermore, mortality was reduced in patients previously treated with ARBs for cardiovascular disorders and later hospitalized for pneumonia (Fedson 2016). Thus, it is reasonable to speculate that ARBs may ameliorate pneumonia in COVID-19 patients, since recent studies have reported that ARBs improve the overall clinical outcome of COVID-19 patients with hypertension (Meng et al 2020).…”

Section: Potential For Arbs To Modulate Covid-19 Pathophysiologymentioning

confidence: 99%

COVID-19, Angiotensin Receptor Blockers, and the Brain

Saavedra

2020

Cell Mol Neurobiol

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“…On the other hand, studies 5 have suggested the use of ACEI might be protective against respiratory complications. The binding of SARS‐CoV‐2 to ACE2 exhausts ACE2, leading to an imbalance of the renin‐angiotensin‐aldosterone system which spirals into acute severe pneumonia.…”

mentioning

confidence: 99%

“…Blocking the renin‐angiotensin‐aldosterone system by ACEI might, therefore, reduce inflammation in COVID‐19 pneumonia, potentially reducing mortality. A recent study 5 compared inflammatory marker found in COVID‐19 positive patients on ACEIs versus non‐ACEIs, revealing that interleukin‐6 levels were reduced in the ACEI group. Large studies are needed to delineate the role of ACEI in treating COVID‐19, ideally both in patients naïve to ACEI and chronic users of ACEI.…”

mentioning

confidence: 99%

ACE inhibitors and COVID‐19: We don't know yet

2020

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The SARS-CoV-2, the causative agent of COVID-19, has been established to gain access to human cells via the ACE2 receptor, similar to the related coronavirus SARS-CoV which led to an outbreak in 2003.A concern with the newer 2019 coronavirus is its 10 to 20-fold higher affinity to the ACE2 receptor that of SARS-CoV-2, aiding its effective human-to-human transmission. ACE2 receptor expression is thought to be upregulated in ACE inhibitors (ACEI) users. As ACEI are used extensively in the treatment of hypertension, there has been concern regarding the risk of using these medications in patients with COVID-19, and whether the use of such ACEI predisposes to COVID-19. ACEI are also used in the treatment regime of other common conditions including diabetes. Consequently, the increased expression of ACE2 would facilitate infection with COVID-19. Therefore, it may be hypothesized that diabetes and hypertension treatment with ACE2-stimulating drugs would increase the risk of developing severe and fatal COVID-19. The recent Chinese clinical studies detailing the clinical characteristics of patients infected by the novel coronavirus disease-19 (COVID-19) infection have confirmed many of these concerns. 1 A study included 1099 patient's laboratory-confirmed COVID-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through 29 January 2020, of which 261 had associated comorbidity. 2 Hypertension yet again was the most common comorbidity with 165 patients, followed by 81 patients with diabetes. A meta-analysis 3 evaluating the comorbidities associated with COVID-19 found similar results. These statistics raise the question of whether hypertension itself is a high-risk comorbidity or is the use of angiotensin-converting-enzyme inhibitor (ACEI) specifically as treatment responsible for these statistics.Despite coronary heart disease (CHD) being the most common chronic condition worldwide, a small percentage of COVID-19 patients suffered from the condition. The lower rates of CHD could be due to the lower ACE2 receptor expression in patients with CAD and heart failure, 4 there by reducing the likelihood of contracting COVID-19. Large cohort studies factoring in ACE2 expression as a variable while comparing the progression of COVID-19 infection in patients would indicate the relevance of ACE2 receptor in COVID-19 mortality and fatality.According to data from the above study, 23.7% of patients with hypertension had a severe COVID-19 infection, followed by diabetes mellitus (16.2%), CHDs (5.8%), and cerebrovascular disease (2.3%).A high percentage (35.9%) of those who had hypertension died or required mechanical ventilation at the intensive care unit, while the same occured in 26.9% of diabetic patients. As ACEIs are predominantly used in hypertension this could potentially explain the high percentage of COVID-19 positive patients who develop a severe infection. Diabetic patients could also be on ACEIs to slow down the progression of vascular complications associated with diabetes, hence t...

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Renin-angiotensin system inhibitors improve the clinical outcomes of COVID-19 patients with hypertension

Cited by 572 publications

References 13 publications

COVID-19 and RAS: Unravelling an Unclear Relationship

COVID-19 and RAS: Unravelling an Unclear Relationship

COVID-19, Angiotensin Receptor Blockers, and the Brain

ACE inhibitors and COVID‐19: We don't know yet

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