scholarly journals Influence of Renin-Angiotensin System Inhibitors on Lower–Respiratory Tract Infections in Type 2 Diabetes: The Fremantle Diabetes Study Phase II

Diabetes Care ◽  
2020 ◽  
Vol 43 (9) ◽  
pp. 2113-2120
Author(s):  
Timothy M.E. Davis ◽  
Wendy A. Davis
Keyword(s):  
Type 2 Diabetes ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Renin Angiotensin System ◽  
Study Phase ◽  
Lower Respiratory Tract Infections ◽  
Angiotensin System ◽  
Tract Infections

scholarly journals Influence of Renin-Angiotensin System Inhibitors on Lower Respiratory Tract Infections in Type 2 Diabetes: The Fremantle Diabetes Study Phase II

2020 ◽  
Author(s):  
Timothy M E Davis ◽  
Wendy A Davis
Keyword(s):  
Type 2 Diabetes ◽  
Respiratory Tract ◽  
Phase Ii ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Study Phase ◽  
Lower Respiratory Tract Infections ◽  
Tract Infections

Objective:<b> </b>To determine whether<b> </b>angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) protect against lower respiratory tract infections complicating type 2 diabetes. <p>Research design and methods:<b> </b>Of 1,732 participants with diabetes recruited to the longitudinal observational Fremantle Diabetes Study Phase II (FDS2) between 2008 and 2011, 1,482 had confirmed type 2 diabetes (mean age of 65.8 years, 51.6% were males, median diabetes duration 9.0 years). All were followed for hospitalizations for/with, or deaths from, pneumonia/influenza ascertained from validated administrative data linkage from study entry to end-2016. Cox and competing risk regression were used to identify independent predictors of this outcome.</p> <p>Results:<b> </b>Two-thirds of participants (n=982) were taking an ACEi and/or ARB at study entry (498 (33.6%) ACEi, 408 (27.5%) ARB, 76 (5.1%) both).<b> </b>During 9,511 person-years of follow-up (mean 6.4±2.0 years), 174 participants had incident pneumonia/influenza (156 hospitalizations, 18 deaths without hospitalization). In Cox regression analysis, baseline ACEi/ARB use was independently associated with a reduced risk of incident pneumonia/influenza (cause-specific hazard ratio (HR) (95% confidence interval) 0.64 (0.45, 0.89), <i>P</i>=0.008). Allowing for the competing risk of death did not change this finding (subdistribution HR 0.67 (0.48, 0.95), <i>P</i>=0.024), and similar reductions were seen for ACEi, ARB alone, and ACEi/ARB combination therapy. There was no significant change in use of ACEi/ARB during follow-up (interaction with ln(time), <i>P</i>=0.70). Other significant predictors of incident pneumonia/influenza were previously reported, clinically plausible variables.</p> <p>Conclusions:<b> </b>ACEi/ARB reduce the risk of pneumonia/influenza in community-based people with type 2 diabetes.<b><br> </b></p>

scholarly journals Influence of Renin-Angiotensin System Inhibitors on Lower Respiratory Tract Infections in Type 2 Diabetes: The Fremantle Diabetes Study Phase II

2020 ◽  
Author(s):  
Timothy M E Davis ◽  
Wendy A Davis
Keyword(s):  
Type 2 Diabetes ◽  
Respiratory Tract ◽  
Phase Ii ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Study Phase ◽  
Lower Respiratory Tract Infections ◽  
Tract Infections

Objective:<b> </b>To determine whether<b> </b>angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) protect against lower respiratory tract infections complicating type 2 diabetes. <p>Research design and methods:<b> </b>Of 1,732 participants with diabetes recruited to the longitudinal observational Fremantle Diabetes Study Phase II (FDS2) between 2008 and 2011, 1,482 had confirmed type 2 diabetes (mean age of 65.8 years, 51.6% were males, median diabetes duration 9.0 years). All were followed for hospitalizations for/with, or deaths from, pneumonia/influenza ascertained from validated administrative data linkage from study entry to end-2016. Cox and competing risk regression were used to identify independent predictors of this outcome.</p> <p>Results:<b> </b>Two-thirds of participants (n=982) were taking an ACEi and/or ARB at study entry (498 (33.6%) ACEi, 408 (27.5%) ARB, 76 (5.1%) both).<b> </b>During 9,511 person-years of follow-up (mean 6.4±2.0 years), 174 participants had incident pneumonia/influenza (156 hospitalizations, 18 deaths without hospitalization). In Cox regression analysis, baseline ACEi/ARB use was independently associated with a reduced risk of incident pneumonia/influenza (cause-specific hazard ratio (HR) (95% confidence interval) 0.64 (0.45, 0.89), <i>P</i>=0.008). Allowing for the competing risk of death did not change this finding (subdistribution HR 0.67 (0.48, 0.95), <i>P</i>=0.024), and similar reductions were seen for ACEi, ARB alone, and ACEi/ARB combination therapy. There was no significant change in use of ACEi/ARB during follow-up (interaction with ln(time), <i>P</i>=0.70). Other significant predictors of incident pneumonia/influenza were previously reported, clinically plausible variables.</p> <p>Conclusions:<b> </b>ACEi/ARB reduce the risk of pneumonia/influenza in community-based people with type 2 diabetes.<b><br> </b></p>

scholarly journals Hypertension, the renin–angiotensin system, and the risk of lower respiratory tract infections and lung injury: implications for COVID-19

2020 ◽  
Vol 116 (10) ◽  
pp. 1688-1699 ◽  
Author(s):  
Reinhold Kreutz ◽  
Engi Abd El-Hady Algharably ◽  
Michel Azizi ◽  
Piotr Dobrowolski ◽  
Tomasz Guzik ◽  
...  
Keyword(s):  
Risk Factor ◽  
Lung Injury ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Renin Angiotensin System ◽  
Converting Enzyme ◽  
Lower Respiratory Tract Infections ◽  
Angiotensin System ◽  
Ras Blockers ◽  
Tract Infections

Abstract Systemic arterial hypertension (referred to as hypertension herein) is a major risk factor of mortality worldwide, and its importance is further emphasized in the context of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection referred to as COVID-19. Patients with severe COVID-19 infections commonly are older and have a history of hypertension. Almost 75% of patients who have died in the pandemic in Italy had hypertension. This raised multiple questions regarding a more severe course of COVID-19 in relation to hypertension itself as well as its treatment with renin–angiotensin system (RAS) blockers, e.g. angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). We provide a critical review on the relationship of hypertension, RAS, and risk of lung injury. We demonstrate lack of sound evidence that hypertension per se is an independent risk factor for COVID-19. Interestingly, ACEIs and ARBs may be associated with lower incidence and/or improved outcome in patients with lower respiratory tract infections. We also review in detail the molecular mechanisms linking the RAS to lung damage and the potential clinical impact of treatment with RAS blockers in patients with COVID-19 and a high cardiovascular and renal risk. This is related to the role of angiotensin-converting enzyme 2 (ACE2) for SARS-CoV-2 entry into cells, and expression of ACE2 in the lung, cardiovascular system, kidney, and other tissues. In summary, a critical review of available evidence does not support a deleterious effect of RAS blockers in COVID-19 infections. Therefore, there is currently no reason to discontinue RAS blockers in stable patients facing the COVID-19 pandemic.

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