Association between Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers and Mortality in Patients with Hypertension Hospitalized with COVID-19

Background: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are common hypertension medications. We aimed to investigate the association between treatment with ACEIs/ARBs and disease severity and mortality in patients with hypertension hospitalized for coronavirus disease 2019 (COVID-19). Methods: Information from the medical records of 180 hospitalized patients diagnosed with COVID-19 infection admitted in 2020 to Loghman Hakim Hospital, Tehran, Iran, was collected. Clinical histories, drug therapies, radiological findings, hospital courses, and outcomes were analyzed in all the patients. The demographic and clinical characteristics of the patients were also analyzed, and the percentage of patients with hypertension taking ACEIs/ARBs was compared between survivors and nonsurvivors. Results: The study population consisted of 180 patients at mean±SD age of 67.76±18.72 years. Hypertension was reported in 72 patients (40.0%). Patients with hypertension were older than those without it (mean±SD age =72.35±12.09 y). Among those with hypertension, death occurred in 33 patients (45.8%), of whom 60.6% were men. Fifty-three patients (73.6%) with hypertension were on ACEIs/ARBs. The ACEIs/ARBs group had a significantly lower mortality rate than the non-ACEIs/ARBs group (37.7% vs 68.4%; OR: 0.192; 95% CI: 0.05–0.68; P=0.011). Conclusion: This single-center study found no harmful effects associated with ACEIs/ARBs treatment. Patients on ACEIs/ARBs had a lower rate of mortality and disease severity than the non-ACEIs/ARBs group. Our study supports the current guideline to continue ACEIs/ARBs in patients with hypertension.

Evaluation on Safety and Efficacy of Selective Anti-Hypertensive Drugs in Patients with Cardiovascular Disease at a Tertiary Care Hospital, India-an Observational Study

Background: Hypertension means persistent elevation of Blood Pressure in arteries. It is the second leading cause of death. The symptoms include Severe Headache, Drowsiness, Vision problem, Nose bleed, fatigue, Confusion. It may lead to various types of Cardiovascular disorders such as Myocardial Infarction, Coronary Artery Disease, Heart Failure. The treatment of Hypertension can be done by Anti-Hypertensive Drugs which include Angiotensin -II Receptor Blockers, Beta Blockers, Angiotensin Converting Enzyme Inhibitors etc. Results: We have done the study to find out the safe and effective drug among various categories of Anti-Hypertensive drugs to treat hypertension in various cardiovascular disease patients. We have collected sample size of 220 out of which 100 were Myocardial Infarction patients,100 were coronary artery disease patients and 20 were Heart Failure patients. The categories of anti-hypertensive drugs selected for our study were Angiotensin-II Receptor Blockers, Beta Blockers and Angiotensin Converting Enzyme Inhibitors. Angiotensin-II Receptor Blockers were prescribed to 31 Myocardial Infarction patients, 31 coronary artery disease patients,8 Heart Failure patients. Beta Blockers were prescribed to 58 Myocardial Infarction patients,58 coronary artery disease patients,7 Heart Failure patients. Angiotensin Converting. Enzyme Inhibitors were prescribed to 10 Myocardial Infarction patients,10 Coronary Artery Disease patients,5 Heart Failure patients. Conclusion: From all the observations, Beta Blockers were observed to be the drugs with maximum efficacy and maximum safety.

Patients with hypertension hospitalized with COVID-19 pneumonia using angiotensinconverting enzyme inhibitors and angiotensin II receptor blockers or other antihypertensives: retrospective analysis of 435 patients

BACKGROUND: The angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARBs) are widely used for the treatment of hypertension (HT). Whether the use of these drugs increases the infectivity of novel coronavirus and results in an additional risk for morbidity and mortality of COVID-19 is a matter of interest. OBJECTIVES: Assess the effect of ACEI/ARBs compared with other hypertensives on the clinical course and outcome in COVID-19 pneumonia. DESIGN: Retrospective. SETTINGS: Tertiary care hospital. PATIENTS AND METHODS: We collected data on adult inpatients with COVID-19 pneumonia using ACEI/ARBs versus other antihypertensives between 15 March 2020, and 15 February 2021. MAIN OUTCOME MEASURES: Severity, clinical course, mortality, and time to PCR negativity between patients using ACEI/ARBs and other antihypertensives. SAMPLE SIZE: 435 RESULTS: ACEI/ARBs were used by 203 patients (46.6%) (median age: 71 [41–94] years), while 232 patients (53.4%) were using other antihypertensives (median age: 69 [22-93] years, P =.645 vs age of ACEI/ARB users). There were no statistically significant differences between the ACEI/ARBs users and non-users in the number of patients admitted to intensive care (65 cases [32%] vs. 74 cases [31.9%], P =.978), the median duration of stay in hospital (8 [1–54] days vs.7 [1–55] days, P =.806) the median duration of ICU stay (8 [1–40] days vs. 6 [1–25] days), and the mortality rate (48 cases [23.6%] vs. 61 [26.3%], P =.525). While the median days before transfer to the ICU was shorter in ACE/ARBI non-users (2 [1–15] days vs. 3 [1–21] days, P =.02), the difference was not important clinically. The median time to PCR negativity was similar in ACEI/ARBs users and non-users (13 [7–34] days for users and 13 [5–45] days for non-users), ( P =.083). CONCLUSIONS: ACEI/ARB use is probably unrelated to poor prognosis in COVID-19 pneumonia inpatients. ACEI/ARBs did not prolong the time to PCR negativity. We conclude that using ACEI/ARBs probably does not increase the infectivity of SARS-CoV-2. LIMITATIONS: Pharmacological therapies were not discussed in detail. The use of corticosteroids may affect the time to PCR negativity. We could not analyze the effect of obesity because of a lack of data. CONFLICT OF INTEREST: None.

Some features of the course of arterial hypertension in patients undergoing a new coronavirus infection (COVID-19)

The aim of the study was to analyze the incidence of arterial hypertension among comorbidities in patients with coronavirus infection, to consider the effect of coronavirus infection on the course of cardiovascular diseases according to instrumental diagnostic methods. Materials and methods: theoretical (analysis and synthesis of studies on the problem); empirical (observation, interviews); methods of quantitative data processing. Results of the study. Based on the analysis of the literature, our own observation and management of patients with arterial hypertension who had new coronavirus infection (COVID 19), we can suggest that therapy with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers should be continued and their withdrawal during the pandemic is not justified, since at present there are no compelling data to discontinue therapy with renin-angiotensin-aldosterone system blockers to prevent infection or Conclusion. To date, there is no proven theory about the role of the renin-angiotensin-aldosterone system and its blockers in the development of complications and outcomes of coronavirus infection, and drugs from the groups of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers. Are still vital drugs that determine the prognosis for patients with arterial hypertension, chronic heart failure, coronary heart disease, for those with diabetes, and discontinuation of treatment can have extremely adverse effects, including increased mortality. And the group of patients with concomitant cardiovascular diseases, long-term recipients of drugs from the group of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, should be considered, “as a risk group requiring more careful monitoring of the condition” with confirmed SARS-CoV-2 infection.