[Preliminary clinical analysis of direct renin inhibitor aliskiren in the treatment of severe coronavirus disease 2019 patients with hypertension].

Objective: To explore the feasibility of direct renin inhibitor aliskiren for the treatment of severe or critical coronavirus disease 2019 (COVID-19) patients with hypertension. Methods: The antihypertensive effects and safety of aliskiren was retrospectively analyzed in three severe and one critical COVID-19 patients with hypertension. Results: Four patients, two males and two females, with an average age of 78 years (66-87 years), were referred to hospital mainly because of respiratory symptoms. Three were diagnosed by positive novel coronavirus 2019 (2019-nCoV) nucleic acid or antibody, and the critical patient with cardiac insufficiency was clinically determined. Two patients were treated with calcium channel antagonist (CCB), one with angiotensin converting enzyme inhibitor (ACEI), and one with angiotensin Ⅱ receptor antagonist (ARB). After admission, ACEI and ARB were discontinued, one patient with heart failure was treated by aliskiren combined with diuretic.Three patients were treated with aliskiren combined with CCB among whom two withdrew CCB due to low blood pressure after 1 to 2 weeks. Based on comprehensive treatment including antiviral and oxygenation treatment, blood pressure was satisfactorily controlled by aliskiren after three to four weeks without serious adverse events. All patients were finally discharged. Conclusion: Our preliminary clinical data shows that antihypertensive effect of aliskiren is satisfactory and safe for severe COVID-19 patients complicated with hypertension.

Respiratory disease, and treatment / thematic poster session anxiety, depressive symptoms, and attitudes about COVID-19 in patients with chronic obstructive pulmonary disease

Rationale: Patients with chronic lung disease, such as chronic obstructive pulmonary disease (COPD), are at higher risk for severe COVID-19 disease. This study evaluated the anxiety and depressive symptoms, and attitudes about COVID-19 in a well-characterized group of patients with COPD enrolled in the Losartan Evaluation for Emphysema (LEEP) trial. Methods: This is an ancillary study of an ongoing LEEP trial evaluating the effect of losartan versus placebo on emphysema progression. From June 2017 to February 2020, 220 participants were enrolled in the 48-week LEEP trial. The main eligibility criteria were FEV1/FVC ratio<70% and FEV1 20-80%, >10 pack-year smoking, and a high resolution CT scan with 5-35% voxel with density <-950 Hounsfield Unit. From May 2020 to November 2020, 156 former and current LEEP participants participated in an ancillary study to evaluate the impact of COVID-19. Participants were interviewed by telephone every 2 months about their functional status and mental health using standardized, validated questionnaires;COPD Assessment Test (CAT), Generalized Anxiety Disorder-7 (GAD7) and the Patient Health Questionnaire-8 (PHQ-8). In addition, participants were asked about their experiences, knowledge, and attitudes about the pandemic. Measurements and Main results: Characteristics of the 156 participants at trial enrollment were median age of 66 y/o, 55% male, 82% white, 70% reported relying on public insurance and the median FEV1 was 48%. At the first interview, a small proportion (13%) had elevated scores for anxiety (GAD7>9) and 18% had elevated scores for depression (PHQ- 8>9), which was similar to the prevalence in another COPD cohort evaluated prior to the pandemic. Regardless, 57% report significant concern that COVID-19 may affect their COPD. The large majority reported practicing recommended infection control measurements and 72% reported staying home more. The majority, 66%, said they were unlikely to receive a vaccine for COVID-19 (prior to the announcement of results of first vaccine trials). Trusted sources of information about the pandemic were doctors and healthcare providers (70%), followed by local news stations (70%), and CDC (61%). Most of the participants had good understanding of the symptoms and mode of transmission route of COVID-19. Conclusion: There was no increase in symptoms of anxiety or depression in patients with moderate-to-severe COPD associated with the pandemic;the prevalence of elevated anxiety and depression were relatively low. Most followed recommended infection control measures. The majority were concerned about the potential effects of COVID-19 on COPD disease. .