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Coronavirus SARS-CoV-2 is responsible for the coronavirus disease (COVID-19) cause of the recent global pandemic, which is causing thousands of deaths worldwide and represents a health challenge with few precedents in human history. The angiotensin 2 conversion enzyme (ACE-2) has been identified as the receptor that facilitates access to SARSCoV-2 in cells;evidence shows that its concentration varies during the various stages of viral infection. Therapeutic agents modifying the renin-angiotensin system (RAS) may be able to modulate the concentration of ACE-2 and the various components of the system. In this article we examine the latest evidence on the association between the use of RAS modifying agents and coronavirus 2019 (COVID-19) disease caused by SARS-CoV-2. Our investigation and critical literature research does not suggest discontinuation of ACEIs/ARBs treatment in clinical practice as there is a lack of robust evidence. However, we recommend further well-structured epidemiological studies investigating this sensitive issue that may provide important new suggestions for implementing guidelines.Copyright © Vitiello A., Ferrara F., 2023.
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BACKGROUND: The pathogenesis of angioedema induced by angiotensin-converting enzyme inhibitors is based on the accumulation of bradykinin as a result of angiotensin-converting enzyme blockade. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binds to the angiotensin-converting enzyme 2 receptor, which may inhibit its production and thereby lead to an increase in bradykinin levels. Thus, SARS-CoV-2 infection may be a likely trigger for the development of angioedema. AIMS: This study aimed to analyze cases of hospitalizations of patients with angioedema associated with the use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers during the coronavirus disease 2019 (COVID-19) pandemic. MATERIALS AND METHODS: This study retrospectively analyzed medical records of patients admitted to the Vitebsk Regional Clinical Hospital between May 2020 and December 2020 with isolated (without urticaria) angioedema while receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. In all patients, smears from the naso and oropharynx for COVID-19 were analyzed by polymerase chain reaction. RESULT(S): Fifteen inpatients (9 men and 6 women) aged 44-72 years were admitted because of emergent events, of which 53.6% had isolated angioedema. In two cases, a concomitant diagnosis of mild COVID-19 infection was established with predominant symptoms of angioedema, including edema localized in the face, tongue, sublingual area, and soft palate. All patients had favorable disease outcomes. CONCLUSION(S): Patients with angiotensin-converting enzyme inhibitor-induced angioedema may require hospitalization to monitor upper respiratory tract patency. There were cases of a combination of angiotensin-converting enzyme inhibitor-induced angioedema and mild COVID-19. Issues requiring additional research include the effect of SARS- CoV-2 infection on the levels of bradykinin and its metabolites, the triggering role of COVID-19 in the development of angioedema in patients receiving angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, recommendations for the management of patients with angiotensin-converting enzyme inhibitor-induced angioedema, and a positive result for COVID-19.Copyright © 2020 Pharmarus Print Media All rights reserved.
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Introduction: The main prevention of cardiovascular disease (CVD) and healthcare cost reduction depend on the early identification and treatment of cardiovascular disease (CVD) risk factors through screening. Hypertension, obesity, a large waist circumference, smoking, poor diets, physical inactivity, and excessive alcohol consumption are well-known and potentially treatable risk factors for cardiovascular disease. This allows for early detection of instances, informs the start of CVD prevention medication, and is also very cost-effective. Method(s): At rural India, between March and August 2021, a cross-sectional survey was conducted in community pharmacies. One thousand two hundred healthy individuals were screened for signs of obesity, high blood pressure, waist circumference, and history of smoking and alcohol intake. A structured questionnaire was used to get participants' physical activity and diet. Result(s): The gender split of the 1200 participants who were screened was 67.8% male and 32.3% female. Participants' ages ranged from 18 to 60 years old in 43.3% of cases, 41 to 60 years old in 26.3%, and over 60 in 30.4% of cases. There were 43.7% of drinkers and 47.3% of smokers, respectively. A BMI of 25 kg/m2 or more indicates being overweight, whereas a BMI of 30 kg/m2 indicates being obese. Using a diagnostic cutoff of >140/90mmHg prevalence of hypertension was 44.3%, and 14.9% out of these were previously hypertensive. 31.5% had high waist circumference, 13.9% had insufficient physical activity, and 34.9% had insufficient intake of fruits and vegetables. Conclusion(s): The majority felt that screening for CVD risk factors was helpful, and more than one-fourth of the study participants had two or more CVD risk factors combined. A cost-effective strategy for the primary prevention of CVD that can have a positive influence on the healthcare delivery system is the capacity to further discover previously undetected risk factors.Copyright © 2023, Global Research Online. All rights reserved.
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Introduction: The respiratory tract infections (RTIs), including pneumonia, influenza and Coronavirus Disease 2019 (COVID-19), are the leading cause of hospitalization and mortality worldwide, contributing to elevated healthcare and societal costs. There is conflicting evidences about the effects of angiotensin converting enzyme inhibitor (ACEIs) or angiotensin II receptor blockers (ARBs) on the susceptibility of RTIs. Method(s): Systematic review of interventional and observational studies that reported use of ACEI or/and ARB on incidence of pneumonia or influenza or COVID-19. Searching was conducted in the databases of PubMed, Excerpta Medica Database (Embase), Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), including the Cochrane Library until April 2022, and references of retrieved relevant articles. We assessed the quality of included studies by using Cochrane Collaboration Risk of Bias tool for Randomized Controlled Trials and Newcastle-Ottawa Scale for observational studies. DerSimonian Laird random-effects meta-analysis was conducted to pool effects for the incidence of pneumonia, influenza and COVID-19. Subgroup analyses were carried according to baseline morbidities (hypertension or cardiovascular diseases, cerebrovascular diseases, chronic kidney disease (CKD) and other non-communicable diseases). Pooled estimates of odds ratios (OR) and corresponding 95% confidence intervals (95% CI) were computed, and heterogeneity among studies was assessed using Cochran's Q test and the I2 metrics, with two tailed P values. Result(s): 73 studies met the inclusion criteria, of which 38 studies assessed the odds of pneumonia, 32 studies assessed Covid-19 and 3 studies assessed influenza. The quality of included studies was moderate. Use of ACEIs was associated with a significantly reduced odds of pneumonia (23 studies: OR 0.74, 95% CI 0.64 to 0.85;I2=76.8%), of COVID-19 (24 studies: OR 0.87, 95% CI 0.82 to 0.92;I2=81.9%) and influenza (3 studies: OR 0.75, 95% CI 0.57 to 0.98, I2=97.7%), compared with control treatment. Use of ARBs was also associated with reduced odds of COVID-19 (25 studies: OR 0.90, 95% CI 0.83 to 0.97;I2=91.9%), but not with odds of pneumonia or influenza. These findings remain consistent in the community population, patients with history of cerebrovascular diseases or cardiovascular diseases, but not in those with CKD, diabetes and chronic obstructive pulmonary diseases. Conclusion(s): The current evidence favours a putative protective role of ACEIs, not ARB in odds of pneumonia, COVID-19 and influenza. Patient populations that may benefit most are those within the community, history of cerebrovascular diseases and cardiovascular diseases. No conflict of interestCopyright © 2023
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Background: The outbreak of a new coronavirus in China in 2019 (COVID-19) caused a global health crisis. Objective(s): This study was performed to investigate the effect of different underlying diseases on mortality in patients with COVID-19. Method(s): This retrospective cohort study was performed on COVID-19 patients admitted to the Shahid Rahimi and Sohada-ye Ashayer teaching hospitals in Khorramabad, Iran, from 2019 to 2021. Data on disease severity, clinical manifestations, mortality, and underlying disorders were collected and analyzed using the SPSS software version 22 at a 95% confidence interval and 0.05 sig-nificance level. Result(s): The study included 9653 men (48%) and 10332 women (52%). Patients with chronic kidney diseases, cancer, chronic obstruc-tive pulmonary disease, hypertension, cardiovascular disease, and diabetes were at higher mortality risk than those without these underlying diseases, respectively. However, there was no significant relationship between asthma and mortality. Also, age > 50 years, male gender, oxygen saturation < 93 on admission, and symptoms lasting <= 5 days were associated with increased mortality. Conclusion(s): Since patients with underlying diseases are at higher mortality risk, they should precisely follow the advice provided by health authorities and receive a complete COVID-19 vaccination series.Copyright © 2022, Author(s).
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Background: One of the most common co-morbidities identified among COVID-19 patients was hypertension. Debates on use of Angiotensin-Converting Enzyme Inhibitors (ACEI) and Angiotensin-Receptor blockers (ARB) emerged due to an interaction of the said drugs with Angiotensin-converting enzyme 2 (ACE2), an enzyme which is a point of entry of coronavirus. This study aims to give an update on the work of Zhang et al13 in exploring the association of ACEI/ARB use on mortality and disease severity. Method(s): This meta-analysis involves review of observational studies among hypertensive COVID-19 patients with composite data on ACEI and ARB use. The literature search included studies published from December 2019 until June 30, 2020. Analyses were performed determining the odds ratio of each event using the raw data obtained from each study. Random effects model and Cochran-Mantel-Haenszel Method were utilized at 95% confidence interval. To check for heterogeneity, X2 test and I2 statistic were calculated. Subgroup analyses on ACEI users and ARB users were also done. Cochrane Review Manager (REVMAN 5.3) was used and Forest plots were generated. In this update, the total population of patients with confirmed COVID-19 infection was more than 50,000 with hypertensive patients comprising more than half of the sample population. The analyses done manifested decreased frequency of both outcomes with ACEI/ARB use. Result(s): The calculated odds ratio for mortality and disease severity were 0.63 and 0.56, respectively. However, a statistically significant heterogeneity existed for both outcomes. Subgroup analyses among ACEI users versus ACEI/ARB non-users (odds ratio for mortality = 0.95, I2 = 0%;and odds ratio for disease severity = 0.30, I2 = 0%), and ARB users versus ACEI/ARB non-users (odds ratio for mortality = 0.70, I2 =f 68%;and odds ratio for disease severity = 0.48, I2 = 77%) also manifested decreased frequency of both outcomes. However, significant heterogeneity exists among the ARB users, which is in contrary among the ACEI users. Conclusion(s): The use of ACEI contributes to a statistically significant reduction of mortality and disease severity among hypertensive patients with confirmed COVID-19 infection. We recommend continuing analysis of association of ACEI and ARB use and clinical outcomes since recent analysis suggests a beneficial effect especially in the ACEI group. At present, our findings are still in line with the current recommendation to not discontinue the use of ACEI and ARB among our hypertensive patients.
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Objective Different hypotheses suggest a contradictory association of statins, angiotensin receptor blockers(ARBs) or angiotensin-converting enzyme(ACE) inhibitors with potential adverse or favorable effects in patients with Coronavirus disease 2019(COVID-19). This study aimed to compare the association of statins, ARB, and ACE inhibitors in COVID-19 and in pneumonia. Design and Method All patients with laboratory-confirmed COVID-19 through April 16, 2020, in Korea were retrieved. We evaluated the association of statins, ARBs, and ACE inhibitors on COVID-19-related mortality within 60 days. Furthermore, a comparison of hazard ratio (HR) was performed between COVID-19 patients and a retrospective cohort of patients hospitalized with pneumonia between January and June 2019 in Korea. Lastly, meta-analysis was performed to compare the results of this study and other reports. Results The median age of the 10,448 COVID-19 patients was 45 years, and statins, ARBs and ACE inhibitors were prescribed in 533 (5.1%), 1,231(11.8%) and 47(0.4%) patients, respectively. As of April 24, 228 patients (2.2%) succumbed to death. After adjusting age, sex, residential area, the history of comorbidities, Cox regression showed significant decrease in HR by 36% associated with statin use (HR 0.635, 95% CI 0.424 - 0.951, p = 0.0274). However, ARBs group showed neutral association (HR 1.034, 95% CI 0.765 - 1.399, p = 0.8270) and ACE inhibitor groups showed insignificant results mainly due to small sample size (HR 0.736, 95% CI 0.314 - 1.726, p = 0.4810). When comparing the HR between COVID-19 patients and a retrospective cohort of patients hospitalized with pneumonia between January and June 2019, the trend of statins and ACE inhibitors showed similar benefit, whereas the protective effect of ARBs observed in the retrospective cohort was lost in the COVID-19 patients. Meta-analysis including the results of this study showed significant benefit of statins and ACE inhibitors, whereas neutral association with ARBs and the mortality. Conclusions Statins were associated with significantly lower mortality of COVID-19, consistent with usual pneumonia patients. While ARBs or ACE inhibitors were not associated with fatal outcome, the possible beneficial effect of ARBs observed in usual pneumonia was attenuated in COVID-19.
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Background: Coronavirus disease 2019 (COVID-19) caused a major pandemic around world. Considering conflicting information on effect of Angiotensin-converting enzyme 2 (ACE2) and inhibitors of this enzyme on COVID19, we aimed to measure levels of ACE2 in COVID-19 patients and investigate determining factors for their outcome. Method(s): This cross-sectional study was performed on 78 COVID-19 patients that referred to Afzalipour tertiary teaching hospital. Patients enrolled into study after confirmation of the diagnosis of COVID-19 by polymerase chain reaction test. We assess plasma ACE2 levels with an Enzyme-linked immunosorbent assay. The patients followed for if they discharged or deceased. Result(s): 58 out of 78 studied patients discharged (74.4%) and 20 ones (25.6%) deceased. The median length of stay in deceased group was 17.5 days and in discharged ones was 10.0 days (P=0.003). The median levels of ACE2 in discharged and deceased patients was (0.6 ng/mL) and (0.5 ng/mL), respectively which showed no significant difference(P<0.116). The median serum ACE2 levels in 19 patients who received Angiotensin-converting enzyme inhibitors or Angiotensin II receptor blockers were significantly different from those who did not (59 patients) (0.53 ng/mL vs 0.59 ng/mL, respectively) (P=0.041). Conclusion(s): The ACE2 serum level was not related to length of stay and nor to the outcome of COVID-19 patients;however, it was lower in patients received ACE inhibitors or ARBs, which may come with this suggestion that further studies might show the ACE inhibitors or ARBs affection on disease severity or patient's outcome.
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Aim: COVID-19 infection has affected the whole world. It has been speculated that the virus might hold on to angiotensin-converting enzyme 2 (ACE 2) surfaces of type 2 alveolar cells. ACE inhibitors and angiotensin receptor antagonists (ARBs) are essential antihypertensive and cardiac failure drugs in the guidelines. In this study, we aimed to find the effect of these drugs on clinical, laboratory courses, and outcomes of COVID-19 patients. Material(s) and Method(s): We included 109 patients in this study. There were 43 patients in the ACE/ARB group and 66 patients in the non-ACE/ARB group. The mean age was 60 years in the ACE/ARB group and 52 years old in the non-ACE/ARB group. Basal symptoms, hemogram, CRP, D-dimer, LDH, Ferritin, AST, duration of hospitalization, percentage of intensive care unit (ICU) need, length of stay in ICU were compared between the groups. Result(s): The mean age in the ACE/ARB group was higher than in the other group and was statistically significant (p=.027). The initial symptoms were not different. There were no differences between the laboratory results of the groups. The ICU need was higher in the patients who do not use the drug than in the users (p<.020). Discussion(s): ACE/ARB usage in COVID-19 patients did not worsen the course of the disease. However, ACE/ARB users before COVID-19 pandemic were taken to ICU at a low rate.Copyright © 2022, Derman Medical Publishing. All rights reserved.
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Introduction: Alport syndrome should be considered in the differential diagnosis of patients with persistent microhematuria. Electron microscopic examination of renal tissue remains the most widely available and applied means for diagnosing AS. The presence of diffuse thickening and multilamellation of the GBM predicts a progressive nephropathy, regardless of family history. Unfortunately, ultrastructural information alone does not establish the mode of transmission in a particular family. Method(s): 18 years-old male patient was followed in the clinic due to persistent microscopic haematuria and proteinuria. Family history is significant for one brother in his early 20s, who started to have the presentation early in life and his initial biopsy showed thin basement membrane disease. The brother subsequently progressed to renal failure and a repeat biopsy confirmed the presence of Alport syndrome. Another brother had end-stage renal disease and underwent renal transplantation. The patient status was revised, and genetic studies confirmed the presence of an autosomal recessive type of Alport syndrome involving collagen for A3 chain COL4A3. His kidney function remained stable initially with an estimated GFR of approximately 90 mL/min/1.73 m2. The most recent eGFR is around 70 ml/min/1.73 m2. His proteinuria disappeared once Losartan 25 mg was added to Ramipril 5 mg. His blood pressure has been on target. Creatinine increased to 147 micromol/L and he was diagnosed as having acute kidney injury on chronic renal disease which was obvious post covid infection, then back to baseline. Current proteinuria 3 g/g Cr on Angiotensin receptor blockers. BP 110/70, all other systemic examination is unremarkable. No hearing or visual abnormalities. Result(s): The initial renal manifestations in early childhood include asymptomatic-persistent microscopic hematuria and rarely gross hematuria. At the onset, the serum creatinine and blood pressure are normal. Over time, proteinuria, hypertension, and progressive renal insufficiency develop. ESRD usually occurs between the ages of 16 and 35 years and rarely can occur between 45 and 60 years. Renal biopsy findings of thinning and multilaminar splitting of the glomerular capillary basement membrane seen on electron microscopic examination are pathognomonic. In 2013, an expert panel issued guidelines recommending genetic testing as the gold standard for the diagnosis of Alport syndrome. Currently, a skin biopsy using commercially available monoclonal antibody against the type IV collagen alpha-5 chain (COL4A5). If the protein is clearly absent in a suspected male, a diagnosis of Alport syndrome can be made without further testing. Conclusion(s): Males with X-linked AS due to a deletion mutation of the alpha 5 chain of type IV collagen usually progress to ESRD by the second or third decade of life. Likewise, patients with autosomal recessive AS due to mutations affecting alpha 3 or 4 chains of type IV collagen tend to progress to ESRD by age 30. Autosomal-dominant AS with heterozygous mutations of COL4A3 or COL4A4 usually has a slower progression of CKD. Treatment is blood pressure control with RAAS inhibitors where clinically appropriate. Cyclosporine may be helpful in some patients with stage I and II CKD with significant proteinuria. Caution using calcineurin inhibitors is indicated in all patients with more advanced CKD stages due to potential nephrotoxicity. No conflict of interestCopyright © 2023
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Essential oils are potential therapeutics for coronavirus disease 2019 (COVID-19), in which some of the volatile compounds of essential oils have been well known for their broad antiviral activities. These therapeutic candidates have been shown to regulate the excessive secretion of pro-inflammatory cytokines, which underlies the pathogenesis of severe COVID-19. We aimed to identify molecular targets of essential oils in disrupting the cell entry and replication of SARS-CoV-2, hence being active as antivirals. Literature searches were performed on PubMed, Scopus, Scillit, and CaPlus/SciFinder (7 December 2022) with a truncated title implying the anti-SARS-CoV-2 activity of essential oil. Data were collected from the eligible studies and described narratively. Quality appraisal was performed on the included studies. A total of eight studies were included in this review;four of which used enzyme inhibition assay, one—pseudo-SARS-CoV-2 culture;two—whole SARS-CoV-2 culture;and one—ACE2-expressing cancer cells. Essential oils may prevent the SARS-CoV-2 infection by targeting its receptors on the cells (ACE2 and TMPRSS2). Menthol, 1,8-cineole, and camphor are among the volatile compounds which serve as potential ACE2 blockers. β-caryophyllene may selectively target the SARS-CoV-2 spike protein and inhibit viral entry. Other interactions with SARS-CoV-2 proteases and RdRp are observed based on molecular docking. In conclusion, essential oils could target proteins related to the SARS-CoV-2 entry and replication. Further studies with improved and uniform study designs should be carried out to optimize essential oils as COVID-19 therapies. © 2023 by the authors.
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Objective: The role of angiotensin converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) in the pandemic context of coronavirus disease 2019 (COVID-19) continues to be debated. Patients with hypertension, diabetes mellitus, chronic renal failure, cerebro-cardiovascular disease, or chronic obstructive pulmonary disease (COPD), who often use ACEi/ARB, may affect risk of severe COVID-19. However, there are no data available on the association of ACEi/ARB use with COVID-19 severity in this population. Design and method: This study is an observational study of patients with a positive SARS-CoV-2 test and inpatient treatment at a healthcare facility, using the registry information of COVIREGI-JP. Our primary outcomes were consisting of in-hospital death, ventilator support, extracorporeal membrane oxygenation support, and ICU admission. Out of the 6,055 patients, 1,921 patients with preexisting hypertension, diabetes mellitus, chronic renal failure, cerebro-cardiovascular disease, or COPD were enrolled. We also evaluated 1,097 patients with hypertension. Results: Factors associated with an increased risk of the primary outcomes were aging, male sex, COPD, severe renal impairment, and diabetes mellitus. No correlations were observed with ACEi/ARB, cerebro-cardiovascular diseases, or hypertension. Associated factors in male patients were aging, renal impairment, hypertension, and diabetes. In female patients, factors associated with an increased risk were aging, ACEi/ARB, renal impairment, and diabetes, whereas hypertension was associated with a lower risk of the primary outcomes. In patients with hypertension, factors associated with an increased risk of the primary outcomes were aging, male sex, severe renal impairment, and diabetes mellitus, but not ACEi/ ARB, cerebro-cardiovascular diseases, or COPD. Conclusions: Independent factors for the primary outcomes were aging, male sex, COPD, severe renal impairment, and diabetes, but not ACEi/ARB, in the COVID-19 patients with preexisting hypertension, diabetes mellitus, chronic renal failure, cerebro-cardiovascular disease or COPD. Based on this registry data analysis, more detailed data collection and analysis is needed with the cooperation of multiple healthcare facilities.
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Objective: The study aims to determine whether ACEI/ARB use associated with an increased probability of viral infection and investigate whether there are differences in disease severity and mortality between ACEI/ARB users and non-ACEI/ARB users. Material and methods: In this retrospective study, 330 patients with severe acute respiratory syndrome coronavirus 2 disease were divided into two groups: patients using ACEI/ARB Blocker and patients not using it. Baseline features and prognoses were compared for the two groups. Results: The rate of intensive care hospitalization in the group using ACE/ARB was significantly (p<0.05) higher than the group not using ACEI/ARB on the day of hospitalization in the intensive care unit. The degree of clinical classification in the group using ACEI/ARB was significantly (p<0.05) higher than the group not using ACE/ARB. The mortality rate in the group using ACE/ARB was significantly (p<0.05) higher than the group not using ACEI/ARB. Conclusion: Although it has been determined that the use of antihypertensive ACEI/ARB in COVID 19 patients is associated with mortality and survival, it has been concluded that the continuation of ACEI/ARB use would be more appropriate for the continuation of antihypertensive treatment.
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Background: The first reports on coronaviruse disease 2019 (COVID-19) revealed an exaggerated mortality rate in hypertensive patients. In this regard, concerns about angiotensin-converting enzyme (ACE) inhibitors’ and angiotensin-receptor blockers’ (ARBs) have been aroused. Our aim in this study was to evaluate the potential bad outcome effect of hypertension and anti-hypertensive therapy on COVID-19. Methods: 183 patients with polymerase-chain-reaction (PCR)-proven COVID-19, who were admitted to our hospital and consulted to cardiology department between 15th of March and 15th of April 2020 were included. Data were recruited from hospital records. Results: Thirty-two out of 183 patients with COVID-19 died in hospital. Hypertension incidence was not statistically different between patients who survived and died (76 [50.3%] vs 19 [59.4%, p = 0.352]). Although the usage rate of ACEI were similar among groups, ARB usage rate was significantly higher in patients who died than survived (11 [34.4%] vs 23 [15.2%], p = 0.011). Binary regression analysis showed an association between ARBs and mortality (OR: 0.032, 95% CI 1.045–2.623, p = 0.032). Conclusion: Our study confirmed previous concerns regarding a potential harmful effects of ARBs on COVID-19 related mortality.
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Aim. To study the dynamics of the lipid profile of hypertensive patients with dyslipidemia who underwent COVID-19. Material and methods. Hypertensive patients with dyslipidemia who underwent COVID-19 [n=126;58 men and 68 women;median age 60 (56.0;65.5) years] examined. Patients were included into two groups: group 1 (n=64) received a single pill combination of lisinopril + amlodipine + rosuvastatin;2 groups (n=62) continued the previous drug treatment. Clinical, demographic, office blood pressure (BP), total cholesterol (TC), low density lipoprotein cholesterol (LDL-c), high density lipoprotein cholesterol, triglycerides, C-reactive protein (CRP) levels were assessed in all patients in 3 visits within 24 weeks. Results. The groups did not differ in prior antihypertensive therapy (except for more frequent use of angiotensin II receptor blockers in group 2, p<0.05), lipid profile and blood pressure parameters at study entry. A decrease in systolic (by 9.5%) and diastolic blood pressure (by 12.1%) after 24 weeks was found in group 1 compared with 4.29% and 5.56%, respectively, in group 2 (p<0.05). A decrease in the level of total cholesterol by 14.5% and LDL-c by 31.4% after 24 weeks was found in group 1 compared with 11.2% and 9.7%, respectively, in group 2 (p<0.05). The level of CRP during the observation period decreased by 53.7% in group 1 versus 43.4% in patients of group 2 (p<0.05). Conclusion. The single pill combination of lisinopril/amlodipine/rosuvastatin in hypertensive patients with dyslipidemia who underwent COVID-19 led to an improvement in lipid profile and blood pressure control.
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Background: Arterial hypertension has been described as one of the main risk factors for poor prognosis in Covid-19. In this context, the role of angiotensin-converting enzyme 2 (ACE2) in this infection has been studied, with studies showing how this enzyme acts as a functional receptor for SARS-CoV-2, favoring the penetration of the virus into the cell. The main objective of this work is to study the impact of chronic antihypertensive treatment in a cohort of SARS-CoV-2 positive patients with arterial hypertension, as well as clinical outcomes during hospitalization. Method: Single-center observational retrospective cohort study conducted at a tertiary level university hospital from 1st March 2020 to 31st May 2020. All adult patients admitted with a diagnosis of COVID-19 and a history of arterial hypertension on chronic treatment with an antihypertensive drug during the three months prior to contracting the infection were included. For the analysis, patients were divided into three groups according to the chronic antihypertensive treatment they were receiving: angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin II receptor antagonists (ARB) or other treatment, excluding those patients who during the three months prior to the start of the study had been on concomitant treatment with ACE inhibitors and ARB, as well as those on treatment with more than four antihypertensive drugs. Results: A total of 475 cases with positive PCR for SARS-CoV-2 cases had hypertension as an associated comorbidity on antihypertensive treatment in the three months prior to admission. The mean age of this cohort of patients was 77.05 (SD 10.95) years, most of them male (56.8%) Regarding the prolonged length of stay variable, 127 patients (26.7%) were admitted for 14 days or more, with no statistically significant differences between the three groups. For patients admitted to the Intensive Care Unit (ICU) (29 patients, 6.1%) no differences were observed between the three study groups either.Regarding the outcome variable, all-cause in-hospital mortality, no statistically significant differences were observed between the groups (p = 0.836). Conclusions: Patients admitted with SARS-CoV2 respiratory infection with a diagnosis of hypertension and pre-admission treatment with an antihypertensive drug showed no statistically significant differences in mortality between those hypertensive patients who received renin-angiotensin-aldosterone system (RAAS) inhibitor antihypertensive drugs and those who received other antihypertensive treatments.
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Background: The are conflicting reports on the effects of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) continued treatment on clinical outcomes in COVID-19 patients. Material and methods: Patients presented with symptoms suggestive of COVID-19 infection were enrolled between 5 April 2021,and 5 June 2021. Patients who survived acute stage of the disease were asked to attend out-patient clinic after six months following COVID-19 infection diagnosis. Results: A total of 162 patients were enrolled in this study. ARB users showed significant independent association with lower fatality rate as compared to ACEI/ARB-naïve patients [OR (CI) = 0.1(0.0-0.5), p = 0.01]. The prevalence of respiratory support use and intensive care unit (ICU) admission was numerically, but not statically significant, lower among ARB users than non-ARB users. The distribution of in-hospital adverse outcome was numerically lower among ACEI users than in non ACEI users, though the association did not reach statistical significance. ARB users showed significant independent association with persistent cough [OR (CI) = 2 (1.1-10), p = 0.02]. No significant differences in other long term symptoms were found between ARB users and nonusers. On the other hand, chest pain showed higher prevalence among ACEI users than in non-ACEI users. After adjusting for baseline comorbidities, chest pain association with ACEI user was not persisted. No significant differences in other long term symptoms were found between ACEI users and nonusers. Conclusion: ARB and ACEI users showed low prevalence of in-hospital adverse outcome compared to ARB/ACEI nonusers. ARB showed significant and independent association with persistent cough.