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Effects of Angiotensin II Receptor Blockers and ACE (Angiotensin-Converting Enzyme) Inhibitors on Virus Infection, Inflammatory Status, and Clinical Outcomes in Patients With COVID-19 and Hypertension: A Single-Center Retrospective Study.
Hypertension. 2020 07; 76(1):51-58.H

Abstract

With the capability of inducing elevated expression of ACE2 (angiotensin-converting enzyme 2), the cellular receptor for severe acute respiratory syndrome coronavirus 2, angiotensin II receptor blockers (ARBs) or ACE inhibitors treatment may have a controversial role in both facilitating virus infection and reducing pathogenic inflammation. We aimed to evaluate the effects of ARBs/ACE inhibitors on coronavirus disease 2019 (COVID-19) in a retrospective, single-center study. One hundred twenty-six patients with COVID-19 and preexisting hypertension at Hubei Provincial Hospital of Traditional Chinese Medicine in Wuhan from January 5 to February 22, 2020, were retrospectively allocated to ARBs/ACE inhibitors group (n=43) and non-ARBs/ACE inhibitors group (n=83) according to their antihypertensive medication. One hundred twenty-five age- and sex-matched patients with COVID-19 without hypertension were randomly selected as nonhypertension controls. In addition, the medication history of 1942 patients with hypertension that were admitted to Hubei Provincial Hospital of Traditional Chinese Medicine from November 1 to December 31, 2019, before the 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/ACE inhibitors usage in patients with hypertension with or without COVID-19 were comparable. Among patients with COVID-19 and hypertension, those received either ARBs/ACE inhibitors or non-ARBs/ACE inhibitors had comparable blood pressure. However, ARBs/ACE inhibitors group had significantly lower concentrations of hs-CRP (high-sensitivity C-reactive protein; P=0.049) and PCT (procalcitonin, P=0.008). Furthermore, a lower proportion of critical patients (9.3% versus 22.9%; P=0.061) and a lower death rate (4.7% versus 13.3%; P=0.216) were observed in ARBs/ACE inhibitors group than non-ARBs/ACE inhibitors group, although these differences failed to reach statistical significance. Our findings thus support the use of ARBs/ACE inhibitors in patients with COVID-19 and preexisting hypertension.

Authors+Show Affiliations

From the Department of Geriatrics, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China (G.Y., Z.T., L.P., J.L., J.C., S.H.). Hubei Provincial Academy of Traditional Chinese Medicine, Wuhan, China (G.Y., Z.T., L.P., J.L., J.C., S.H.).From the Department of Geriatrics, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China (G.Y., Z.T., L.P., J.L., J.C., S.H.). Hubei Provincial Academy of Traditional Chinese Medicine, Wuhan, China (G.Y., Z.T., L.P., J.L., J.C., S.H.).Zhongnan Hospital of Wuhan University, China (L.Z.).Department of Preventive Medicine, School of Basic Medicine, Hubei University of Chinese Medicine, Wuhan, China (M.Y.).From the Department of Geriatrics, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China (G.Y., Z.T., L.P., J.L., J.C., S.H.). Hubei Provincial Academy of Traditional Chinese Medicine, Wuhan, China (G.Y., Z.T., L.P., J.L., J.C., S.H.).From the Department of Geriatrics, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China (G.Y., Z.T., L.P., J.L., J.C., S.H.). Hubei Provincial Academy of Traditional Chinese Medicine, Wuhan, China (G.Y., Z.T., L.P., J.L., J.C., S.H.).From the Department of Geriatrics, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China (G.Y., Z.T., L.P., J.L., J.C., S.H.). Hubei Provincial Academy of Traditional Chinese Medicine, Wuhan, China (G.Y., Z.T., L.P., J.L., J.C., S.H.).Wuhan Blood Center, China (R.Y.).Department of Immunology (J.H.), School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Department of Pathogen Biology (Y.H.), School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.From the Department of Geriatrics, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China (G.Y., Z.T., L.P., J.L., J.C., S.H.). Hubei Provincial Academy of Traditional Chinese Medicine, Wuhan, China (G.Y., Z.T., L.P., J.L., J.C., S.H.).

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32348166

Citation

Yang, Guang, et al. "Effects of Angiotensin II Receptor Blockers and ACE (Angiotensin-Converting Enzyme) Inhibitors On Virus Infection, Inflammatory Status, and Clinical Outcomes in Patients With COVID-19 and Hypertension: a Single-Center Retrospective Study." Hypertension (Dallas, Tex. : 1979), vol. 76, no. 1, 2020, pp. 51-58.
Yang G, Tan Z, Zhou L, et al. Effects of Angiotensin II Receptor Blockers and ACE (Angiotensin-Converting Enzyme) Inhibitors on Virus Infection, Inflammatory Status, and Clinical Outcomes in Patients With COVID-19 and Hypertension: A Single-Center Retrospective Study. Hypertension. 2020;76(1):51-58.
Yang, G., Tan, Z., Zhou, L., Yang, M., Peng, L., Liu, J., Cai, J., Yang, R., Han, J., Huang, Y., & He, S. (2020). Effects of Angiotensin II Receptor Blockers and ACE (Angiotensin-Converting Enzyme) Inhibitors on Virus Infection, Inflammatory Status, and Clinical Outcomes in Patients With COVID-19 and Hypertension: A Single-Center Retrospective Study. Hypertension (Dallas, Tex. : 1979), 76(1), 51-58. https://doi.org/10.1161/HYPERTENSIONAHA.120.15143
Yang G, et al. Effects of Angiotensin II Receptor Blockers and ACE (Angiotensin-Converting Enzyme) Inhibitors On Virus Infection, Inflammatory Status, and Clinical Outcomes in Patients With COVID-19 and Hypertension: a Single-Center Retrospective Study. Hypertension. 2020;76(1):51-58. PubMed PMID: 32348166.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of Angiotensin II Receptor Blockers and ACE (Angiotensin-Converting Enzyme) Inhibitors on Virus Infection, Inflammatory Status, and Clinical Outcomes in Patients With COVID-19 and Hypertension: A Single-Center Retrospective Study. AU - Yang,Guang, AU - Tan,Zihu, AU - Zhou,Ling, AU - Yang,Min, AU - Peng,Lang, AU - Liu,Jinjin, AU - Cai,Jingling, AU - Yang,Ru, AU - Han,Junyan, AU - Huang,Yafei, AU - He,Shaobin, Y1 - 2020/04/29/ PY - 2020/4/30/pubmed PY - 2020/6/23/medline PY - 2020/4/30/entrez KW - COVID-19 KW - angiotensin receptor blocker KW - angiotensin-converting enzyme inhibitors KW - coronavirus KW - hypertension KW - inflammation SP - 51 EP - 58 JF - Hypertension (Dallas, Tex. : 1979) JO - Hypertension VL - 76 IS - 1 N2 - With the capability of inducing elevated expression of ACE2 (angiotensin-converting enzyme 2), the cellular receptor for severe acute respiratory syndrome coronavirus 2, angiotensin II receptor blockers (ARBs) or ACE inhibitors treatment may have a controversial role in both facilitating virus infection and reducing pathogenic inflammation. We aimed to evaluate the effects of ARBs/ACE inhibitors on coronavirus disease 2019 (COVID-19) in a retrospective, single-center study. One hundred twenty-six patients with COVID-19 and preexisting hypertension at Hubei Provincial Hospital of Traditional Chinese Medicine in Wuhan from January 5 to February 22, 2020, were retrospectively allocated to ARBs/ACE inhibitors group (n=43) and non-ARBs/ACE inhibitors group (n=83) according to their antihypertensive medication. One hundred twenty-five age- and sex-matched patients with COVID-19 without hypertension were randomly selected as nonhypertension controls. In addition, the medication history of 1942 patients with hypertension that were admitted to Hubei Provincial Hospital of Traditional Chinese Medicine from November 1 to December 31, 2019, before the 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/ACE inhibitors usage in patients with hypertension with or without COVID-19 were comparable. Among patients with COVID-19 and hypertension, those received either ARBs/ACE inhibitors or non-ARBs/ACE inhibitors had comparable blood pressure. However, ARBs/ACE inhibitors group had significantly lower concentrations of hs-CRP (high-sensitivity C-reactive protein; P=0.049) and PCT (procalcitonin, P=0.008). Furthermore, a lower proportion of critical patients (9.3% versus 22.9%; P=0.061) and a lower death rate (4.7% versus 13.3%; P=0.216) were observed in ARBs/ACE inhibitors group than non-ARBs/ACE inhibitors group, although these differences failed to reach statistical significance. Our findings thus support the use of ARBs/ACE inhibitors in patients with COVID-19 and preexisting hypertension. SN - 1524-4563 UR - https://www.unboundmedicine.com/medline/citation/32348166/Effects_of_Angiotensin_II_Receptor_Blockers_and_ACE__Angiotensin_Converting_Enzyme__Inhibitors_on_Virus_Infection_Inflammatory_Status_and_Clinical_Outcomes_in_Patients_With_COVID_19_and_Hypertension:_A_Single_Center_Retrospective_Study_ L2 - https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.120.15143?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -