Is prior use of renin-angiotensin system (RAS) inhibitors associated with more favourable outcome in COVID-19 hospitalized patients?
-
Mohammad-Mehdi Mehrabi Nejad
,
Hamed Bagheri
,
Seyyed Hosein Mousavi
,
Faeze Salahshour
,
Niloofar Ayoobi Yazdi
,
Babak Shekarchi
Abstract
Objective: We aimed to investigate the extent of pulmonary involvement and adverse outcomes in patients receiving angiotensin-converting enzyme inhibitor (ACEI)/ angiotensin II receptor blocker (ARB) versus who did not, in hospitalized coronavirus infectious disease 2019 (COVID-19) patients. Methods: All COVID-19 patients with a positive polymerase chain reaction (PCR) test, who were admitted to our tertiary referral hospitals in Tehran, Iran between January 2021 and May 2021, and had an on-admission chest computed tomography (CT) scan, were included. The patients were divided into two groups (receiving ACEI/ARB and who did not) for further analysis. The outcomes of interest in our study were the extent of pulmonary involvement, intensive care unit (ICU) admission, and death. Results: A total of 893 participants (mean age of 58.6±15.4 years; female, 522 (58.4%)) were enrolled. Among them, 368 (41.2%) participants had hypertension, and use of ACEI/ARB was reported in 183 (20.5%) participants. Of all, 409 (45.8%) participants required ICU admission, and 259 (29%) participants succumbed to death. We found that participants who received ACEI/ARB were less likely to progress critical disease and experienced significantly lower ICU admission (P=0.022) and death (P<0.001). On multivariable analysis adjusting for age, sex, and comorbidities, this relationship remained statistically significant for death [OR: 0.23 (0.14-0.38); P<0.001] and ICU admission [OR: 0.49 (0.32-0.73); P=0.001]. Conclusion: Our findings showed that COVID-19 patients who receiving ACEI/ARB prior to hospitalization vs. those who did not, had more favorable outcomes.
1. Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020;181(2):271–80.e8.
2. Igase M, Kohara K, Nagai T, Miki T, Ferrario CM. Increased expression of angiotensin converting enzyme 2 in conjunction with reduction of neointima by angiotensin II type 1 receptor blockade. Hypertens Res. 2008;31(3):553-9.
3. Babaniamansour S, Atarodi A, Babaniamansour P, Firouzabadi MD, Majidi M, Karkon-Shayan S. Clinical Findings and Prognosis of COVID-19 Patients with Benign Prostatic Hyperplasia: A Case Series. J Biomed Res Environ Sci. 2021;2(5):328-32.
4. Jalali A, Karimialavijeh E, Babaniamansour P, Aliniagerdroudbari E, Babaniamansour S. Predicting the 30-day Adverse Outcomes of Non-Critical New-Onset COVID-19 Patients in Emergency Departments based on their Lung CT Scan Findings; A Pilot Study for Derivation an Emergency Scoring Tool. Front Emerg Med. 2021;5(4):e40.
5. Abkhoo A, Shaker E, Mehrabinejad M-M, Azadbakht J, Sadighi N, Salahshour F. Factors Predicting Outcome in Intensive Care Unit-Admitted COVID-19 Patients: Using Clinical, Laboratory, and Radiologic Characteristics. Crit Care Res Pract. 2021;2021:9941570.
6. Yazdi NA, Seyedalinaghi S, Jafari F, Jafari S, Hasannezad M, Koochak HE, et al. Predictors of The Chest CT Score in COVID-19 Patients: A Cross-Sectional Study. Virol J. 2021;18(1):225.
7. Kuba K, Imai Y, Rao S, Gao H, Guo F, Guan B, et al. A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus–induced lung injury. Nat Med. 2005;11(8):875-9.
8. Tai W, He L, Zhang X, Pu J, Voronin D, Jiang S, et al. Characterization of the receptor-binding domain (RBD) of 2019 novel coronavirus: implication for development of RBD protein as a viral attachment inhibitor and vaccine. Cell Mol Immunol. 2020;17(6):613–20.
9. Dalan R, Ang LW, Tan WY, Fong SW, Tay WC, Chan YH, et al. The association of hypertension and diabetes pharmacotherapy with COVID-19 severity and immune signatures: an observational study. Eur Heart J Cardiovasc Pharmacother. 2021;7(3):e48-51.
10. Zhang P, Zhu L, Cai J, Lei F, Qin JJ, Xie J, et al. Association of inpatient use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers with mortality among patients with hypertension hospitalized with COVID-19. Circ Res. 2020;126(12):1671-81.
11. Zhou F, Liu YM, Xie J, Li H, Lei F, Yang H, et al. Comparative impacts of ACE (angiotensin-converting enzyme) inhibitors versus angiotensin II receptor blockers on the risk of COVID-19 mortality. Hypertension. 2020;76(2):e15-e7.
12. Liabeuf S, Moragny J, Bennis Y, Batteux B, Brochot E, Schmit JL, et al. Association between renin–angiotensin system inhibitors and COVID-19 complications. Eur Heart J Cardiovasc Pharmacother. 2021;7(5):426-34.
13. Selçuk M, Çınar T, Keskin M, Çiçek V, Kılıç Ş, Kenan B, et al. Is the use of ACE inb/ARBs associated with higher in-hospital mortality in Covid-19 pneumonia patients? Clin Exp Hypertens. 2020;42(8):738-42.
14. Lee HW, Yoon CH, Jang EJ, Lee CH. Renin-angiotensin system blocker and outcomes of COVID-19: a systematic review and meta-analysis. Thorax. 2021;76(5):479-86.
15. Bavishi C, Whelton PK, Mancia G, Corrao G, Messerli FH. Renin–angiotensin-system inhibitors and all-cause mortality in patients with COVID-19: a systematic review and meta-analysis of observational studies. J Hypertens. 2021;39(4):784-94.
16. Feng Z, Yu Q, Yao S, Luo L, Zhou W, Mao X, et al. Early prediction of disease progression in COVID-19 pneumonia patients with chest CT and clinical characteristics. Nat Commun. 2020;11:4968.
17. Pan F, Ye T, Sun P, Gui S, Liang B, Li L, et al. Time course of lung changes at chest CT during recovery from coronavirus disease 2019 (COVID-19). Radiology. 2020;295(3):715-21.
18. Ma Z, Wang MP, Liu L, Yu S, Wu TR, Zhao L, et al. Does taking an angiotensin inhibitor increase the risk for COVID-19?–a systematic review and meta-analysis. Aging (Albany NY). 2021;13(8):10853.
19. Yang G, Tan Z, Zhou L, Yang M, Peng L, Liu J, 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):51-8.
20. Bean DM, Kraljevic Z, Searle T, Bendayan R, Pickles A, Folarin A, et al. Treatment with ACE-inhibitors is associated with less severe disease with SARS-Covid-19 infection in a multi-site UK acute Hospital Trust. MedRxiv. 2020.
21. Tan ND, Qiu Y, Xing XB, Ghosh S, Chen MH, Mao R. Associations between angiotensin-converting enzyme inhibitors and Angiotensin II Receptor blocker use, gastrointestinal symptoms, and mortality among patients with COVID-19. Gastroenterology. 2020;159(3):1170-2. e1.
22. Salahshour F, Mehrabinejad M-M, Toosi MN, Gity M, Ghanaati H, Shakiba M, et al. Clinical and chest CT features as a predictive tool for COVID-19 clinical progress: introducing a novel semi-quantitative scoring system. Eur Radiol. 2021;31(7):5178-88.
23. Yang G, Tan Z, Zhou L, Yang M, Peng L, Liu J, et al. Effects of ARBs and ACEIs on virus infection, inflammatory status and clinical outcomes in COVID-19 patients with hypertension: a single center retrospective study. Hypertension. 2020;76(1):51-8.
24. Diaz JH. Hypothesis: angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may increase the risk of severe COVID-19. J Travel Med. 2020:taaa041.
25. Bozkurt B, Kovacs R, Harrington B. Joint HFSA/ACC/AHA statement addresses concerns re: using RAAS antagonists in COVID-19. J Card Fail. 2020;26(5):370.
26. Mehrabi Nejad MM, Moosaie F, Dehghanbanadaki H, Haji Ghadery A, Shabani M, Tabary M, et al. Immunogenicity of COVID-19 mRNA vaccines in immunocompromised patients: a systematic review and meta-analysis. Eur J Med Res. 2022;27:23.
2. Igase M, Kohara K, Nagai T, Miki T, Ferrario CM. Increased expression of angiotensin converting enzyme 2 in conjunction with reduction of neointima by angiotensin II type 1 receptor blockade. Hypertens Res. 2008;31(3):553-9.
3. Babaniamansour S, Atarodi A, Babaniamansour P, Firouzabadi MD, Majidi M, Karkon-Shayan S. Clinical Findings and Prognosis of COVID-19 Patients with Benign Prostatic Hyperplasia: A Case Series. J Biomed Res Environ Sci. 2021;2(5):328-32.
4. Jalali A, Karimialavijeh E, Babaniamansour P, Aliniagerdroudbari E, Babaniamansour S. Predicting the 30-day Adverse Outcomes of Non-Critical New-Onset COVID-19 Patients in Emergency Departments based on their Lung CT Scan Findings; A Pilot Study for Derivation an Emergency Scoring Tool. Front Emerg Med. 2021;5(4):e40.
5. Abkhoo A, Shaker E, Mehrabinejad M-M, Azadbakht J, Sadighi N, Salahshour F. Factors Predicting Outcome in Intensive Care Unit-Admitted COVID-19 Patients: Using Clinical, Laboratory, and Radiologic Characteristics. Crit Care Res Pract. 2021;2021:9941570.
6. Yazdi NA, Seyedalinaghi S, Jafari F, Jafari S, Hasannezad M, Koochak HE, et al. Predictors of The Chest CT Score in COVID-19 Patients: A Cross-Sectional Study. Virol J. 2021;18(1):225.
7. Kuba K, Imai Y, Rao S, Gao H, Guo F, Guan B, et al. A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus–induced lung injury. Nat Med. 2005;11(8):875-9.
8. Tai W, He L, Zhang X, Pu J, Voronin D, Jiang S, et al. Characterization of the receptor-binding domain (RBD) of 2019 novel coronavirus: implication for development of RBD protein as a viral attachment inhibitor and vaccine. Cell Mol Immunol. 2020;17(6):613–20.
9. Dalan R, Ang LW, Tan WY, Fong SW, Tay WC, Chan YH, et al. The association of hypertension and diabetes pharmacotherapy with COVID-19 severity and immune signatures: an observational study. Eur Heart J Cardiovasc Pharmacother. 2021;7(3):e48-51.
10. Zhang P, Zhu L, Cai J, Lei F, Qin JJ, Xie J, et al. Association of inpatient use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers with mortality among patients with hypertension hospitalized with COVID-19. Circ Res. 2020;126(12):1671-81.
11. Zhou F, Liu YM, Xie J, Li H, Lei F, Yang H, et al. Comparative impacts of ACE (angiotensin-converting enzyme) inhibitors versus angiotensin II receptor blockers on the risk of COVID-19 mortality. Hypertension. 2020;76(2):e15-e7.
12. Liabeuf S, Moragny J, Bennis Y, Batteux B, Brochot E, Schmit JL, et al. Association between renin–angiotensin system inhibitors and COVID-19 complications. Eur Heart J Cardiovasc Pharmacother. 2021;7(5):426-34.
13. Selçuk M, Çınar T, Keskin M, Çiçek V, Kılıç Ş, Kenan B, et al. Is the use of ACE inb/ARBs associated with higher in-hospital mortality in Covid-19 pneumonia patients? Clin Exp Hypertens. 2020;42(8):738-42.
14. Lee HW, Yoon CH, Jang EJ, Lee CH. Renin-angiotensin system blocker and outcomes of COVID-19: a systematic review and meta-analysis. Thorax. 2021;76(5):479-86.
15. Bavishi C, Whelton PK, Mancia G, Corrao G, Messerli FH. Renin–angiotensin-system inhibitors and all-cause mortality in patients with COVID-19: a systematic review and meta-analysis of observational studies. J Hypertens. 2021;39(4):784-94.
16. Feng Z, Yu Q, Yao S, Luo L, Zhou W, Mao X, et al. Early prediction of disease progression in COVID-19 pneumonia patients with chest CT and clinical characteristics. Nat Commun. 2020;11:4968.
17. Pan F, Ye T, Sun P, Gui S, Liang B, Li L, et al. Time course of lung changes at chest CT during recovery from coronavirus disease 2019 (COVID-19). Radiology. 2020;295(3):715-21.
18. Ma Z, Wang MP, Liu L, Yu S, Wu TR, Zhao L, et al. Does taking an angiotensin inhibitor increase the risk for COVID-19?–a systematic review and meta-analysis. Aging (Albany NY). 2021;13(8):10853.
19. Yang G, Tan Z, Zhou L, Yang M, Peng L, Liu J, 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):51-8.
20. Bean DM, Kraljevic Z, Searle T, Bendayan R, Pickles A, Folarin A, et al. Treatment with ACE-inhibitors is associated with less severe disease with SARS-Covid-19 infection in a multi-site UK acute Hospital Trust. MedRxiv. 2020.
21. Tan ND, Qiu Y, Xing XB, Ghosh S, Chen MH, Mao R. Associations between angiotensin-converting enzyme inhibitors and Angiotensin II Receptor blocker use, gastrointestinal symptoms, and mortality among patients with COVID-19. Gastroenterology. 2020;159(3):1170-2. e1.
22. Salahshour F, Mehrabinejad M-M, Toosi MN, Gity M, Ghanaati H, Shakiba M, et al. Clinical and chest CT features as a predictive tool for COVID-19 clinical progress: introducing a novel semi-quantitative scoring system. Eur Radiol. 2021;31(7):5178-88.
23. Yang G, Tan Z, Zhou L, Yang M, Peng L, Liu J, et al. Effects of ARBs and ACEIs on virus infection, inflammatory status and clinical outcomes in COVID-19 patients with hypertension: a single center retrospective study. Hypertension. 2020;76(1):51-8.
24. Diaz JH. Hypothesis: angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may increase the risk of severe COVID-19. J Travel Med. 2020:taaa041.
25. Bozkurt B, Kovacs R, Harrington B. Joint HFSA/ACC/AHA statement addresses concerns re: using RAAS antagonists in COVID-19. J Card Fail. 2020;26(5):370.
26. Mehrabi Nejad MM, Moosaie F, Dehghanbanadaki H, Haji Ghadery A, Shabani M, Tabary M, et al. Immunogenicity of COVID-19 mRNA vaccines in immunocompromised patients: a systematic review and meta-analysis. Eur J Med Res. 2022;27:23.
| Files | ||
| Issue | Vol 6 No 3 (2022): Summer (July) | |
| Section | Original article | |
| DOI | 10.18502/fem.v6i3.9396 | |
| Keywords | ||
| Angiotensin-Converting Enzyme Inhibitors Angiotensin Receptor Antagonists COVID-19 Hypertension Patient Outcome Assessment X-Ray Computed Tomography | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Mehrabi Nejad M-M, Bagheri H, Mousavi SH, Salahshour F, Ayoobi Yazdi N, Shekarchi B. Is prior use of renin-angiotensin system (RAS) inhibitors associated with more favourable outcome in COVID-19 hospitalized patients?. Front Emerg Med. 2022;6(3):e34.
Downloads
Download data is not yet available.
