Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers with Coronavirus Disease 2019 Severity and Mortality

Patricia Díaz-Guardiola; Virginia Martín-Borge; Cristina García-Fernández; María Teresa Ramírez-Prieto; Marcela Irma Ramírez-Belmar; Gema García-Romero; Esther de la Calle; José Antonio Balsa

doi:doi:10.11648/j.ajim.20200805.12

Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers with Coronavirus Disease 2019 Severity and Mortality

Patricia Díaz-Guardiola, Virginia Martín-Borge, Cristina García-Fernández, María Teresa Ramírez-Prieto, Marcela Irma Ramírez-Belmar, Gema García-Romero, Esther de la Calle, José Antonio Balsa

Published in American Journal of Internal Medicine (Volume 8, Issue 5)

Received: 21 July 2020 Accepted: 3 August 2020 Published: 18 August 2020

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Abstract

Background: A potential association between use of angiotensin-converting–enzyme inhibitors (ACEI) or angiotensin-receptor blockers (ARB) and coronavirus disease 2019 (COVID-19) severity has been suggested. We conducted a retrospective study to investigate the association between ACEI/ARB use and COVID-19 severity and mortality. Methods: The first 1,000 consecutive patients with COVID-19 who were attended in the emergency department at the Infanta Sofía University Hospital were included. Clinical data was manually extracted by reviewing medical records, and the ACEI/ARB prescription was assessed from an electronic pharmacy database. The primary endpoints were critical COVID-19 and mortality. Results: A total of 241 (24.1%) patients had a critical COVID-19 and 171 (17.1%) died. ACEI use was associated with critical COVID-19 (OR 1.90, 95% CI 1.34-2.70), and with mortality (OR 1.98, 95% CI 1.35-2.91) in the unadjusted analysis, but not after adjusting by age, sex and comorbidities (OR 1.15 95% CI 0.69-1.94, and OR 1.00 95% CI 0.56-1.77, respectively). Similarly, ARB use was associated with critical COVID-19 (OR 1.58, 95% CI 1.11-2.58), although not with mortality (OR 1.47, 95% CI 0.98-2.19) in the unadjusted analysis, but not after adjusting by age, sex and comorbidities (OR 0.97, 95% CI 0.57-1.65, and OR 0.74, 95% CI 0.41-1.33, respectively). Conclusion: These results suggest that the use of ACEI/ARB is not independently associated with COVID-19 severity and mortality.

Published in	American Journal of Internal Medicine (Volume 8, Issue 5)
DOI	10.11648/j.ajim.20200805.12
Page(s)	204-210
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

ACEI/ARB, COVID-19 Severity, COVID-19 Mortality

References

[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. e8-280. e8. doi: 10.1016/j.cell.2020.02.052.
[2]	Ferrario CM, Jessup J, Chappell MC, Averill DB, Brosnihan KB, Tallant EA, et al. Effect of angiotensin-converting enzyme inhibition and angiotensin II receptor blockers on cardiac angiotensin-converting enzyme 2. Circulation 2005; 111 (20): 2605–2610. doi: 10.1161/CIRCULATIONAHA.104.510461.
[3]	Soler MJ, Ye M, Wysocki J, William J, Lloveras J, Batlle D. Localization of ACE2 in the renal vasculature: amplification by angiotensin II type 1 receptor blockade using telmisartan. Am J Physiol Renal Physiol 2009; 296 (2): F398-F405. doi: 10.1152/ajprenal.90488.2008.
[4]	Li Y, Zeng Z, Li Y, Huang W, Zhou M, Zhang X, et al. Angiotensin-converting Enzyme Inhibition Attenuates Lipopolysaccharide-Induced Lung Injury by Regulating the Balance Between Angiotensin-Converting Enzyme and Angiotensin-Converting Enzyme 2 and Inhibiting Mitogen-Activated Protein Kinase Activation. Shock 2015; 43 (4): 395-404. doi: 10.1097/SHK.0000000000000302.
[5]	Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395 (10229): 1054–1062. doi: 10.1016/S0140-6736(20)30566-3.
[6]	Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020; 382 (18): 1708-1720. doi: 10.1056/NEJMoa2002032.
[7]	Esler M, Esler D. Can angiotensin receptor-blocking drugs perhaps be harmful in the COVID-19 pandemic? J Hypertens 2020; 38 (5): 781-782. doi: 10.1097/HJH.0000000000002450.
[8]	Sommerstein R, Kochen MM, Messerli FH, Gräni C. Coronavirus Disease 2019 (COVID-19): Do Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers Have a Biphasic Effect? J Am Heart Assoc 2020; 9 (7): e016509. doi: 10.1161/JAHA.120.016509.
[9]	Mancia G, Rea F, Ludergnani M, Apolone G, Corrao G. Renin-angiotensin-aldosterone system blockers and the risk of Covid-19. N Engl J Med 2020; 382 (25): 2431-2440. doi: 10.1056/NEJMoa2006923.
[10]	Reynolds HR, Adhikari S, Pulgarin C, Troxel AB, Iturrate E, Johnson SB, et al. Renin-angiotensin-aldosterone system inhibitors and risk of covid-19. N Engl J Med 2020; 382 (25): 2441-2448. doi: 10.1056/NEJMoa2008975.
[11]	de Abajo FJ, Rodríguez-Martín S, Lerma V, Mejía-Abril G, Aguilar M, García-Luque A, et al. Use of Renin-Angiotensin-Aldosterone System Inhibitors and Risk of COVID-19 Requiring Admission to Hospital: A Case-Population Study. Lancet 2020; 395 (10238): 1705-1714. doi: 10.1016/S0140-6736(20)31030-8.
[12]	Li J, Wang X, Chen J, Zhang H, Deng A. Association of renin-angiotensin system inhibitors with severity or risk of death in patients with hypertension hospitalized for coronavirus disease 2019 (COVID-19) infection in Wuhan, China. JAMA Cardiol 2020; 5 (7): 1-6. doi: 10.1001/jamacardio.2020.1624.
[13]	Bean DM, Kraljevic Z, Searle T, Bendayan R, O'Gallagher K, Pickles A, et al. ACE-inhibitors and Angiotensin-2 Receptor Blockers Are Not Associated With Severe SARS-COVID19 Infection in a Multi-Site UK Acute Hospital Trust. Eur J Heart Fail 2020 Jun 2; doi: 10.1002/ejhf.1924.
[14]	Imai Y, Kuba K, Rao S, Huan Y, Guo F, Guan B, et al. Angiotensin-converting enzyme 2 protects from severe acute lung failure. Nature 2005; 436 (7047): 112-6. doi: 10.1038/nature03712.
[15]	Vaduganathan M, Vardeny O, Michel T, McMurray JJ, Pfeffer MA, Solomon SD, et al. Renin-angiotensin aldosterone system inhibitors in patients with covid-19. N Engl J Med. 2020 382 (17): 1653-1659. doi: 10.1056/NEJMsr2005760.
[16]	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): 1671-1681. doi: 10.1161/CIRCRESAHA.120.317134.
[17]	Zhou F, Liu YM, Xie J, Li H, Lei F, Yang H, et al. Comparative Impacts of Angiotensin Converting Enzyme Inhibitors Versus Angiotensin II Receptor Blockers on the Risk of COVID-19 Mortality. Hypertension 2020; 76 (2): e15-e17. doi: 10.1161/HYPERTENSIONAHA.120.15622.
[18]	World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: interim guidance. March 13, 2020 (https://www.who.int/ docs/ default -source/coronaviruse/ clinical –management-of-novel-cov.pdf).
[19]	Han DP, Penn-Nicholson A, Cho MW. Identification of Critical Determinants on ACE2 for SARS-CoV Entry and Development of a Potent Entry Inhibitor. Virology 2006; 350 (1): 15-25. doi: 10.1016/j.virol.2006.01.029.
[20]	Yoon SS, Margaret D Carroll MD, Fryar CD. Hypertension Prevalence and Control Among Adults: United States, 2011-2014. NCHS Data Brief. 2015; 220: 1-8.
[21]	Menéndez E, Delgado E, Fernández-Vega F, Prieto MA, Bordiú E, Calle A, et al. Prevalence, Diagnosis, Treatment, and Control of Hypertension in Spain. Results of the Di@bet.es Study. Rev Esp Cardiol (Engl Ed) 2016; 69 (6): 572-8. doi: 10.1016/j.rec.2015.11.034.
[22]	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. doi: 10.1038/nm1267.
[23]	Mehta N, Kalra A, Nowacki AS, Anjewierden S, Han Z, Bhat P, et al. Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Testing Positive for Coronavirus Disease 2019 (COVID-19). JAMA Cardiol 2020 May 5; e201855. doi: 10.1001/jamacardio.2020.1855.
[24]	Jarcho JA, Ingelfinger JR, Hamel MB, D'Agostino RB, Harrington DP. Inhibitors of the Renin-Angiotensin-Aldosterone System and Covid-19. N Engl J Med 2020; 382 (25): 2462-2464. doi: 10.1056/NEJMe2012924.
[25]	Guo X, Zhu Y, Hong Y. Decreased Mortality of COVID-19 with Renin-Angiotensin-Aldosterone System Inhibitors Therapy in Patients with Hypertension: A Meta-Analysis. Hypertension 2020; 76 (2): e13-e14. doi: 10.1161/HYPERTENSIONAHA.120.15572.
[26]	Mackey K, King VJ, Gurley S, Kiefer M, Liederbauer E, Vela K, et al. Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults. Ann Intern Med 2020 May 15; M20-1515. doi: 10.7326/M20-1515.
[27]	Engin AB, Engin ED, Engin A. Two Important Controversial Risk Factors in SARS-CoV-2 Infection: Obesity and Smoking. Environ Toxicol Pharmacol 2020; 78: 103411. doi: 10.1016/j.etap.2020.103411.
[28]	Landsberg L, Aronne LJ, Beilin LJ, Burke V, Igel LI, Lloyd-Jones D, et al. Obesity-related hypertension: pathogenesis, cardiovascular risk, andtreatment −a position paper of the Obesity Society and the American Societyof Hypertension. Obesity (Silver Spring) 2013; 21 (1): 8-24. doi: 10.1002/oby.20181.
[29]	DeFronzo RA. Pathogenesis of Type 2 Diabetes Mellitus. Med Clin North Am 2004; 88 (4): 787-835. doi: 10.1016/j.mcna.2004.04.013.
[30]	Lavie CJ, De Schutter A, Parto P, Jahangir E, Kokkinos P, Ortega FB, et al. Obesity and prevalence of cardiovascular diseases and prognosis: the obesity paradox updated. Prog Cardiovasc Dis 2016; 58 (5): 537–47. doi: 10.1016/j.pcad.2016.01.008.
[31]	Wang Y, Chen X, Song Y, Caballero B, Cheskin LJ. Association Between Obesity and Kidney Disease: A Systematic Review and Meta-Analysis Kidney Int 2008; 73 (1): 19-33. doi: 10.1038/sj.ki.5002586.
[32]	Wu JT, Leung K, Bushman M, Kishore N, Niehus R, de Salazar PM, et al. Estimating Clinical Severity of COVID-19 From the Transmission Dynamics in Wuhan, China. Nat Med 2020; 26 (4): 506-510. doi: 10.1038/s41591-020-0822-7.
[33]	Verity R, Okell LC, Dorigatti I, Winskill P, Whittaker C, Imai N, et al. Estimates of the Severity of Coronavirus Disease 2019: A Model-Based Analysis. Lancet Infect Dis 2020; 20 (6): 669-677. doi: 10.1016/S1473-3099(20)30243-7.
[34]	Thompson WW, Shay DK, Weintraub E, Brammer L, Cox N, Anderson LJ, et al. Mortality Associated With Influenza and Respiratory Syncytial Virus in the United States. JAMA 2003; 289 (2): 179-86. doi: 10.1001/jama.289.2.179.

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APA Style

Patricia Díaz-Guardiola, Virginia Martín-Borge, Cristina García-Fernández, María Teresa Ramírez-Prieto, Marcela Irma Ramírez-Belmar, et al. (2020). Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers with Coronavirus Disease 2019 Severity and Mortality. American Journal of Internal Medicine, 8(5), 204-210. https://doi.org/10.11648/j.ajim.20200805.12

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ACS Style

Patricia Díaz-Guardiola; Virginia Martín-Borge; Cristina García-Fernández; María Teresa Ramírez-Prieto; Marcela Irma Ramírez-Belmar, et al. Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers with Coronavirus Disease 2019 Severity and Mortality. Am. J. Intern. Med. 2020, 8(5), 204-210. doi: 10.11648/j.ajim.20200805.12

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AMA Style

Patricia Díaz-Guardiola, Virginia Martín-Borge, Cristina García-Fernández, María Teresa Ramírez-Prieto, Marcela Irma Ramírez-Belmar, et al. Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers with Coronavirus Disease 2019 Severity and Mortality. Am J Intern Med. 2020;8(5):204-210. doi: 10.11648/j.ajim.20200805.12

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@article{10.11648/j.ajim.20200805.12,
  author = {Patricia Díaz-Guardiola and Virginia Martín-Borge and Cristina García-Fernández and María Teresa Ramírez-Prieto and Marcela Irma Ramírez-Belmar and Gema García-Romero and Esther de la Calle and José Antonio Balsa},
  title = {Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers with Coronavirus Disease 2019 Severity and Mortality},
  journal = {American Journal of Internal Medicine},
  volume = {8},
  number = {5},
  pages = {204-210},
  doi = {10.11648/j.ajim.20200805.12},
  url = {https://doi.org/10.11648/j.ajim.20200805.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20200805.12},
  abstract = {Background: A potential association between use of angiotensin-converting–enzyme inhibitors (ACEI) or angiotensin-receptor blockers (ARB) and coronavirus disease 2019 (COVID-19) severity has been suggested. We conducted a retrospective study to investigate the association between ACEI/ARB use and COVID-19 severity and mortality. Methods: The first 1,000 consecutive patients with COVID-19 who were attended in the emergency department at the Infanta Sofía University Hospital were included. Clinical data was manually extracted by reviewing medical records, and the ACEI/ARB prescription was assessed from an electronic pharmacy database. The primary endpoints were critical COVID-19 and mortality. Results: A total of 241 (24.1%) patients had a critical COVID-19 and 171 (17.1%) died. ACEI use was associated with critical COVID-19 (OR 1.90, 95% CI 1.34-2.70), and with mortality (OR 1.98, 95% CI 1.35-2.91) in the unadjusted analysis, but not after adjusting by age, sex and comorbidities (OR 1.15 95% CI 0.69-1.94, and OR 1.00 95% CI 0.56-1.77, respectively). Similarly, ARB use was associated with critical COVID-19 (OR 1.58, 95% CI 1.11-2.58), although not with mortality (OR 1.47, 95% CI 0.98-2.19) in the unadjusted analysis, but not after adjusting by age, sex and comorbidities (OR 0.97, 95% CI 0.57-1.65, and OR 0.74, 95% CI 0.41-1.33, respectively). Conclusion: These results suggest that the use of ACEI/ARB is not independently associated with COVID-19 severity and mortality.},
 year = {2020}
}

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TY  - JOUR
T1  - Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers with Coronavirus Disease 2019 Severity and Mortality
AU  - Patricia Díaz-Guardiola
AU  - Virginia Martín-Borge
AU  - Cristina García-Fernández
AU  - María Teresa Ramírez-Prieto
AU  - Marcela Irma Ramírez-Belmar
AU  - Gema García-Romero
AU  - Esther de la Calle
AU  - José Antonio Balsa
Y1  - 2020/08/18
PY  - 2020
N1  - https://doi.org/10.11648/j.ajim.20200805.12
DO  - 10.11648/j.ajim.20200805.12
T2  - American Journal of Internal Medicine
JF  - American Journal of Internal Medicine
JO  - American Journal of Internal Medicine
SP  - 204
EP  - 210
PB  - Science Publishing Group
SN  - 2330-4324
UR  - https://doi.org/10.11648/j.ajim.20200805.12
AB  - Background: A potential association between use of angiotensin-converting–enzyme inhibitors (ACEI) or angiotensin-receptor blockers (ARB) and coronavirus disease 2019 (COVID-19) severity has been suggested. We conducted a retrospective study to investigate the association between ACEI/ARB use and COVID-19 severity and mortality. Methods: The first 1,000 consecutive patients with COVID-19 who were attended in the emergency department at the Infanta Sofía University Hospital were included. Clinical data was manually extracted by reviewing medical records, and the ACEI/ARB prescription was assessed from an electronic pharmacy database. The primary endpoints were critical COVID-19 and mortality. Results: A total of 241 (24.1%) patients had a critical COVID-19 and 171 (17.1%) died. ACEI use was associated with critical COVID-19 (OR 1.90, 95% CI 1.34-2.70), and with mortality (OR 1.98, 95% CI 1.35-2.91) in the unadjusted analysis, but not after adjusting by age, sex and comorbidities (OR 1.15 95% CI 0.69-1.94, and OR 1.00 95% CI 0.56-1.77, respectively). Similarly, ARB use was associated with critical COVID-19 (OR 1.58, 95% CI 1.11-2.58), although not with mortality (OR 1.47, 95% CI 0.98-2.19) in the unadjusted analysis, but not after adjusting by age, sex and comorbidities (OR 0.97, 95% CI 0.57-1.65, and OR 0.74, 95% CI 0.41-1.33, respectively). Conclusion: These results suggest that the use of ACEI/ARB is not independently associated with COVID-19 severity and mortality.
VL  - 8
IS  - 5
ER  -

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Author Information

Patricia Díaz-Guardiola

Department of Endocrinology and Nutrition, Infanta Sofía University Hospital, San Sebastián de los Reyes, Spain
Virginia Martín-Borge

Department of Endocrinology and Nutrition, Infanta Sofía University Hospital, San Sebastián de los Reyes, Spain
Cristina García-Fernández

Department of Preventive Medicine, Infanta Sofía University Hospital, San Sebastián de los Reyes, Spain
María Teresa Ramírez-Prieto

Department of Pneumology, Infanta Sofía University Hospital, San Sebastián de los Reyes, Spain
Marcela Irma Ramírez-Belmar

Department of Endocrinology and Nutrition, Infanta Sofía University Hospital, San Sebastián de los Reyes, Spain
Gema García-Romero

Department of Endocrinology and Nutrition, Infanta Sofía University Hospital, San Sebastián de los Reyes, Spain
Esther de la Calle

Department of Endocrinology and Nutrition, Infanta Sofía University Hospital, San Sebastián de los Reyes, Spain
José Antonio Balsa

Department of Endocrinology and Nutrition, Infanta Sofía University Hospital, San Sebastián de los Reyes, Spain

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APA Style

Patricia Díaz-Guardiola, Virginia Martín-Borge, Cristina García-Fernández, María Teresa Ramírez-Prieto, Marcela Irma Ramírez-Belmar, et al. (2020). Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers with Coronavirus Disease 2019 Severity and Mortality. American Journal of Internal Medicine, 8(5), 204-210. https://doi.org/10.11648/j.ajim.20200805.12

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ACS Style

Patricia Díaz-Guardiola; Virginia Martín-Borge; Cristina García-Fernández; María Teresa Ramírez-Prieto; Marcela Irma Ramírez-Belmar, et al. Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers with Coronavirus Disease 2019 Severity and Mortality. Am. J. Intern. Med. 2020, 8(5), 204-210. doi: 10.11648/j.ajim.20200805.12

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AMA Style

Patricia Díaz-Guardiola, Virginia Martín-Borge, Cristina García-Fernández, María Teresa Ramírez-Prieto, Marcela Irma Ramírez-Belmar, et al. Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers with Coronavirus Disease 2019 Severity and Mortality. Am J Intern Med. 2020;8(5):204-210. doi: 10.11648/j.ajim.20200805.12

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@article{10.11648/j.ajim.20200805.12,
  author = {Patricia Díaz-Guardiola and Virginia Martín-Borge and Cristina García-Fernández and María Teresa Ramírez-Prieto and Marcela Irma Ramírez-Belmar and Gema García-Romero and Esther de la Calle and José Antonio Balsa},
  title = {Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers with Coronavirus Disease 2019 Severity and Mortality},
  journal = {American Journal of Internal Medicine},
  volume = {8},
  number = {5},
  pages = {204-210},
  doi = {10.11648/j.ajim.20200805.12},
  url = {https://doi.org/10.11648/j.ajim.20200805.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20200805.12},
  abstract = {Background: A potential association between use of angiotensin-converting–enzyme inhibitors (ACEI) or angiotensin-receptor blockers (ARB) and coronavirus disease 2019 (COVID-19) severity has been suggested. We conducted a retrospective study to investigate the association between ACEI/ARB use and COVID-19 severity and mortality. Methods: The first 1,000 consecutive patients with COVID-19 who were attended in the emergency department at the Infanta Sofía University Hospital were included. Clinical data was manually extracted by reviewing medical records, and the ACEI/ARB prescription was assessed from an electronic pharmacy database. The primary endpoints were critical COVID-19 and mortality. Results: A total of 241 (24.1%) patients had a critical COVID-19 and 171 (17.1%) died. ACEI use was associated with critical COVID-19 (OR 1.90, 95% CI 1.34-2.70), and with mortality (OR 1.98, 95% CI 1.35-2.91) in the unadjusted analysis, but not after adjusting by age, sex and comorbidities (OR 1.15 95% CI 0.69-1.94, and OR 1.00 95% CI 0.56-1.77, respectively). Similarly, ARB use was associated with critical COVID-19 (OR 1.58, 95% CI 1.11-2.58), although not with mortality (OR 1.47, 95% CI 0.98-2.19) in the unadjusted analysis, but not after adjusting by age, sex and comorbidities (OR 0.97, 95% CI 0.57-1.65, and OR 0.74, 95% CI 0.41-1.33, respectively). Conclusion: These results suggest that the use of ACEI/ARB is not independently associated with COVID-19 severity and mortality.},
 year = {2020}
}

Copy | Download

TY  - JOUR
T1  - Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers with Coronavirus Disease 2019 Severity and Mortality
AU  - Patricia Díaz-Guardiola
AU  - Virginia Martín-Borge
AU  - Cristina García-Fernández
AU  - María Teresa Ramírez-Prieto
AU  - Marcela Irma Ramírez-Belmar
AU  - Gema García-Romero
AU  - Esther de la Calle
AU  - José Antonio Balsa
Y1  - 2020/08/18
PY  - 2020
N1  - https://doi.org/10.11648/j.ajim.20200805.12
DO  - 10.11648/j.ajim.20200805.12
T2  - American Journal of Internal Medicine
JF  - American Journal of Internal Medicine
JO  - American Journal of Internal Medicine
SP  - 204
EP  - 210
PB  - Science Publishing Group
SN  - 2330-4324
UR  - https://doi.org/10.11648/j.ajim.20200805.12
AB  - Background: A potential association between use of angiotensin-converting–enzyme inhibitors (ACEI) or angiotensin-receptor blockers (ARB) and coronavirus disease 2019 (COVID-19) severity has been suggested. We conducted a retrospective study to investigate the association between ACEI/ARB use and COVID-19 severity and mortality. Methods: The first 1,000 consecutive patients with COVID-19 who were attended in the emergency department at the Infanta Sofía University Hospital were included. Clinical data was manually extracted by reviewing medical records, and the ACEI/ARB prescription was assessed from an electronic pharmacy database. The primary endpoints were critical COVID-19 and mortality. Results: A total of 241 (24.1%) patients had a critical COVID-19 and 171 (17.1%) died. ACEI use was associated with critical COVID-19 (OR 1.90, 95% CI 1.34-2.70), and with mortality (OR 1.98, 95% CI 1.35-2.91) in the unadjusted analysis, but not after adjusting by age, sex and comorbidities (OR 1.15 95% CI 0.69-1.94, and OR 1.00 95% CI 0.56-1.77, respectively). Similarly, ARB use was associated with critical COVID-19 (OR 1.58, 95% CI 1.11-2.58), although not with mortality (OR 1.47, 95% CI 0.98-2.19) in the unadjusted analysis, but not after adjusting by age, sex and comorbidities (OR 0.97, 95% CI 0.57-1.65, and OR 0.74, 95% CI 0.41-1.33, respectively). Conclusion: These results suggest that the use of ACEI/ARB is not independently associated with COVID-19 severity and mortality.
VL  - 8
IS  - 5
ER  -

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