Angiotensin Drugs and COVID-19: More Reassuring Data
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Initial data from one Chinese center on the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) in patients hospitalized with COVID-19 appear to give some further reassurance about continued use of these drugs. The report from one hospital in Wuhan found that among patients with hypertension hospitalized with the COVID-19 virus, there was no difference in disease severity or death rate in patients taking ACE inhibitors or ARBs and those not taking such medications.

The study adds to another recent report in a larger number of COVID-19 patients from nine Chinese hospitals that suggested a beneficial effect of ACE inhibitors or ARBs on mortality.

Additional Studies:

Two other similar studies have also been recently released. Another study from China included a small sample of 42 hospitalized patients with COVID-19 on antihypertensive therapy. Those on ACE inhibitor/ARB therapy had a lower rate of severe disease and a trend toward a lower level of IL-6 in peripheral blood. In addition, patients on ACE inhibitor/ARB therapy had increased CD3+ and CD8+ T-cell counts in peripheral blood and decreased peak viral load compared with other antihypertensive drugs.

And a preliminary study found that treatment with ACE inhibitors was associated with a reduced risk of rapidly deteriorating severe COVID-19 disease. This study reports on 205 acute inpatients with COVID-19 at King's College Hospital and Princess Royal University Hospital, London, UK. Of these, 51.2% had hypertension, 30.2% had diabetes, and 14.6% had ischemic heart disease or heart failure. Of the 37 patients on ACE inhibitors, five (14%) died or required critical care support compared with 29% (48/168) of patients not taking an ACE inhibitor.

New Wuhan Study:

The authors report on a case series of 1178 patients hospitalized with COVID-19 at the Central Hospital of Wuhan, Hubei, China, between January 15 and March 15, 2020. Patients were a median age of 55 years, and 46% were men. They had an overall inhospital mortality rate of 11%. Of the 1178 patients, 362 (30.7%) had a diagnosis of hypertension. These patients were older (median age, 66 years) and had a greater prevalence of chronic diseases. Patients with hypertension also had more severe manifestations of COVID-19 compared to those without hypertension, including higher rates of acute respiratory distress syndrome and inhospital mortality (21.3% vs 6.5%). Of the 362 patients with hypertension, 31.8% were taking ACE inhibitors or ARBs.

Specifically regarding ACE inhibitors/ARBs, there was no difference between those with severe versus nonsevere illness in the use of ACE inhibitors, ARBs, or the composite of ACE inhibitors or ARBs. Similarly, there were no differences in nonsurvivors and survivors in the use of ACE inhibitors; ARBs, or the composite of ACE inhibitors or ARBs.

The frequency of severe illness and death also did not differ between those treated with and without ACE inhibitors/ARBs in patients with hypertension and other various chronic conditions.

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