Renin-angiotensin system inhibitors improve the clinical outcomes of COVID-19 patients with hypertension

The COVID-19 outbreak caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to endanger global health and to hamper the world economy. This outbreak started in December 2019 in Wuhan, Hubei Province. Unfortunately, currently, there is still no specific and effective treatment for COVID-19. Evidence shows that elderly people with SARS-CoV-2 infections and cardiovascular diseases, including hypertension, are at risk of developing severe cases. This study was approved by the Shenzhen Third People’s Hospital Ethical Committee. Verbal informed consent was obtained from all patients or patients’ family members. We performed a retrospective review of medical records from hospitalized patients with COVID-19 admitted to the Shenzhen Third People’s Hospital from 11 January to 23 February 2020. The information on patients with hypertension was extracted from all enrolled COVID-19 patients. It was reported that the RAS plays a critical role in regulating hypertension and acute lung injury caused by viruses, such as SARS and H7N9. Changes in RAS activity are related to the pathogenesis of hypertension and inflammatory lung disease. Targeting RAS is an effective antihypertension therapeutic strategy. ACEIs and ARB, which inhibit the ACE/Ang II/AT1R system, are commonly used drugs for hypertensive patients. Recent evidence suggests that hypertensive COVID-19 patients are predisposed to develop severe cases. Thus, it is important to determine the effect of RAS inhibitors on COVID-19 patients with hypertension. Thus, it was suggested that it is beneficial for COVID-19 patients to use ACEIs/ARBs to inhibit the RAS. However, until now, no confirmed clinical evidence has been available. In this study, COVID-19 patients with hypertension were enrolled, and we found that ACEI/ARB therapy attenuated the inflammatory response, potentially through the inhibition of IL-6 levels, which is consistent with the findings that ACEI and ARB therapy alleviated LPS-induced pneumonic injury. Taken together, this is the first clinical evidence demonstrating that RAS inhibitors improve the clinical outcomes of COVID-19 patients with hypertension, suggesting that these patients could benefit from the persistent or preferential usage of ACEI/ARB for antihypertensive treatment. To read more- https://www.tandfonline.com/doi/full/10.1080/22221751.2020.1746200

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