scholarly journals Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Withdrawal Is Associated with Higher Mortality in Hospitalized Patients with COVID-19

2021 ◽  
Vol 10 (12) ◽  
pp. 2642
Author(s):  
Emilia Roy-Vallejo ◽  
Aquilino Sánchez Purificación ◽  
José Torres Peña ◽  
Beatriz Sánchez Moreno ◽  
Francisco Arnalich ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Angiotensin Converting Enzyme ◽  
Angiotensin Receptor Blockers ◽  
Invasive Mechanical Ventilation ◽  
Hospitalized Patients ◽  
Angiotensin Ii Receptor Blocker ◽  
Composite Outcome ◽  
Converting Enzyme ◽  
Icu Admission ◽  
All Cause Mortality

Our main aim was to describe the effect on the severity of ACEI (angiotensin-converting enzyme inhibitor) and ARB (angiotensin II receptor blocker) during COVID-19 hospitalization. A retrospective, observational, multicenter study evaluating hospitalized patients with COVID-19 treated with ACEI/ARB. The primary endpoint was the incidence of the composite outcome of prognosis (IMV (invasive mechanical ventilation), NIMV (non-invasive mechanical ventilation), ICU admission (intensive care unit), and/or all-cause mortality). We evaluated both outcomes in patients whose treatment with ACEI/ARB was continued or withdrawn. Between February and June 2020, 11,205 patients were included, mean age 67 years (SD = 16.3) and 43.1% female; 2162 patients received ACEI/ARB treatment. ACEI/ARB treatment showed lower all-cause mortality (p < 0.0001). Hypertensive patients in the ACEI/ARB group had better results in IMV, ICU admission, and the composite outcome of prognosis (p < 0.0001 for all). No differences were found in the incidence of major adverse cardiovascular events. Patients previously treated with ACEI/ARB continuing treatment during hospitalization had a lower incidence of the composite outcome of prognosis than those whose treatment was withdrawn (RR 0.67, 95%CI 0.63–0.76). ARB was associated with better survival than ACEI (HR 0.77, 95%CI 0.62–0.96). ACEI/ARB treatment during COVID-19 hospitalization was associated with protection on mortality. The benefits were greater in hypertensive, those who continued treatment, and those taking ARB.

scholarly journals Effect of in-hospital treatment with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on mortality and complications in patients hospitalized for COVID-19: a large Spanish cohort study

2021 ◽  
Author(s):  
Emilia Roy-Vallejo ◽  
Aquilino Sánchez Purificación ◽  
José David Torres Peña ◽  
Beatriz Sánchez Moreno ◽  
Francisco Arnalich ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Angiotensin Ii ◽  
Angiotensin Converting Enzyme ◽  
Beneficial Effect ◽  
Invasive Mechanical Ventilation ◽  
Composite Outcome ◽  
Converting Enzyme ◽  
Angiotensin Ii Receptor ◽  
Hypertensive Patients ◽  
All Cause Mortality

AbstractBackgroundThe use of ACEI (Angiotensin-Converting Enzyme Inhibitor) and ARB (Angiotensin II Receptor Blocker) in COVID-19 remains controversial. Our main aim was to describe the effect of ACEI/ARB treatment during COVID-19 hospitalization on mortality and complications.MethodsRetrospective, observational, multicenter study, part of the SEMI-COVID-19 Registry, comparing patients with COVID-19 treated with ACEI/ARB during hospitalization to those not treated. The primary endpoint was incidence of the composite outcome of prognosis (IMV [Invasive Mechanical Ventilation], NIMV [Non-Invasive Mechanical Ventilation], ICU admission [Intensive Care Unit], and/or all-cause mortality). The secondary endpoint was incidence of MACE (Major Adverse Cardiovascular Events). We evaluated both outcomes in patients whose treatment with ACEI/ARB continued or was withdrawn during hospitalization.ResultsBetween February and June 2020, 11,205 patients were included, with mean age 67 years (SD=16.3) and 43.1% female; 2,162 patients received ACEI/ARB treatment. ACEI/ARB treatment showed a protective effect on all-cause mortality (p<.0001). In hypertensive patients it was also protective in terms of IMV, ICU admission, and the composite outcome of prognosis (p<.0001 for all). No differences were found in incidence of MACE. Patients previously treated with ACEI/ARB who continued treatment during hospitalization had a lower incidence of the composite outcome of prognosis than those whose treatment was withdrawn (RR 0.67, 95%CI 0.63-0.76). ARB had a more beneficial effect on survival than ACEI (HR 0.77, 95%CI 0.62-0.96).ConclusionACEI/ARB treatment during COVID-19 hospitalization had a protective effect on mortality. The benefits were greater in hypertensive patients, those who continued treatment during hospitalization, and those taking ARB.SummaryTreatment with ACEI/ARB during COVID-19 hospitalization showed a beneficial effect on mortality in the general population. The benefit was greater in hypertensive patients, in those who maintained treatment during hospitalization and those taking ARB.

scholarly journals Association of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Blockers With Severity of COVID-19: A Multicenter, Prospective Study

2020 ◽  
pp. 107424842097627
Author(s):  
Hakeam A. Hakeam ◽  
Muhannad Alsemari ◽  
Zainab Al Duhailib ◽  
Leen Ghonem ◽  
Saad A. Alharbi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Angiotensin Ii ◽  
Angiotensin Converting Enzyme ◽  
Enzyme Inhibitors ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Hospital Death ◽  
Composite Outcome ◽  
Converting Enzyme ◽  
Converting Enzyme Inhibitors ◽  
Icu Admission

Background: Speculations whether treatment with angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin II receptor blockers (ARB) predisposes to severe coronavirus disease 2019 (COVID-19) or worsens its outcomes. This study assessed the association of ACE-I/ARB therapy with the development of severe COVID-19. Methods: This multi-center, prospective study enrolled patients hospitalized for COVID-19 and receiving one or more antihypertensive agents to manage either hypertension or cardiovascular disease. ACE-I/ARB therapy associations with severe COVID-19 on the day of hospitalization, intensive care unit (ICU) admission, mechanical ventilation and in-hospital death on follow-up were tested using a multivariate logistic regression model adjusted for age, obesity, and chronic illnesses. The composite outcome of mechanical ventilation and death was examined using the adjusted Cox multivariate regression model. Results: Of 338 enrolled patients, 245 (72.4%) were using ACE-I/ARB on the day of hospital admission, and 197 continued ACE-I/ARB therapy during hospitalization. Ninety-eight (29%) patients had a severe COVID-19, which was not significantly associated with the use of ACE-I/ARB (OR 1.17, 95% CI 0.66-2.09; P = .57). Prehospitalization ACE-I/ARB therapy was not associated with ICU admission, mechanical ventilation, or in-hospital death. Continuing ACE-I/ARB therapy during hospitalization was associated with decreased mortality (OR 0.22, 95% CI 0.073-0.67; P = .008). ACE-I/ARB use was not associated with developing the composite outcome of mechanical ventilation and in-hospital death (HR 0.95, 95% CI 0.51-1.78; P = .87) versus not using ACE-I/ARB. Conclusion: Patients with hypertension or cardiovascular diseases receiving ACE-I/ARB therapy are not at increased risk for severe COVID-19 on admission to the hospital. ICU admission, mechanical ventilation, and mortality are not associated with ACE-I/ARB therapy. Maintaining ACE-I/ARB therapy during hospitalization for COVID-19 lowers the likelihood of death. Clinical Trial Registration: ClinicalTrials.gov, NCT4357535.

scholarly journals Mortality and other outcomes of patients with coronavirus disease pneumonia admitted to the emergency department: A prospective observational Brazilian study

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244532
Author(s):  
Rodrigo A. Brandão Neto ◽  
Julio F. Marchini ◽  
Lucas O. Marino ◽  
Julio C. G. Alencar ◽  
Felippe Lazar Neto ◽  
...  
Keyword(s):  
Emergency Department ◽  
Multivariate Analysis ◽  
Angiotensin Ii ◽  
Angiotensin Converting Enzyme ◽  
Angiotensin Converting Enzyme Inhibitor ◽  
Enzyme Inhibitor ◽  
Angiotensin Ii Receptor Blocker ◽  
Converting Enzyme ◽  
Angiotensin Ii Receptor ◽  
All Cause Mortality

Background The first cases of coronavirus disease (COVID-19) in Brazil were diagnosed in February 2020. Our Emergency Department (ED) was designated as a COVID-19 exclusive service. We report our first 500 confirmed COVID-19 pneumonia patients. Methods From 14 March to 16 May 2020, we enrolled all patients admitted to our ED that had a diagnosis of COVID-19 pneumonia. Infection was confirmed via nasopharyngeal swabs or tracheal aspirate PCR. The outcomes included hospital discharge, invasive mechanical ventilation, and in-hospital death, among others. Results From 2219 patients received in the ED, we included 506 with confirmed COVID-19 pneumonia. We found that 333 patients were discharged home (65.9%), 153 died (30.2%), and 20 (3.9%) remained in the hospital. A total of 300 patients (59.3%) required ICU admission, and 227 (44.9%) needed invasive ventilation. The multivariate analysis found age, number of comorbidities, extension of ground glass opacities on chest CT and troponin with a direct relationship with all-cause mortality, whereas dysgeusia, use of angiotensin converting enzyme inhibitor or angiotensin-ii receptor blocker and number of lymphocytes with an inverse relationship with all-cause mortality Conclusions This was a sample of severe patients with COVID-19, with 59.2% admitted to the ICU and 41.5% requiring mechanical ventilator support. We were able to ascertain the outcome in majority (96%) of patients. While the overall mortality was 30.2%, mortality for intubated patients was 55.9%. Multivariate analysis agreed with data found in other studies although the use of angiotensin converting enzyme inhibitor or angiotensin-ii receptor blocker as a protective factor could be promising but would need further studies. Trial registration The study was registered in the Brazilian registry of clinical trials: RBR-5d4dj5.

Abstract 14077: One-year Outcome After PCI in Patients Treated Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers - Subanalysis From Multicenter Registry -

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Inagaki YUSUKE ◽  
Kentaro Jujo ◽  
Hiroyuki Tanaka ◽  
Toshiaki Oka ◽  
KAZUHO KAMISHIMA ◽  
...  
Keyword(s):  
Angiotensin Converting Enzyme ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
All Cause Mortality ◽  
Receptor Blockers ◽  
One Year

Background: The prescription of inhibitors for renin-angiotensin-aldosterone system (RAAS) is associated with improved prognosis but have respectively different mechanisms of action in patients with coronary artery disease (CAD). We aimed to compare the clinical outcomes between angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) therapy in patients with CAD undergoing percutaneous coronary intervention (PCI). Methods: This study is a subanalysis from the TWINCRE registry that is a multicentral prospective cohort including patients who underwent PCI. After excluding 18 patients who received both ACEi and ARB from 2,896 registered patients, we ultimately evaluated 369 patients treated with ACEi, 492 with ARB and 541 without ACEi or ARB. The primary endpoint was a major adverse cardiovascular and cerebrovascular events (MACCE) including death from any cause, acute coronary syndrome, stent thrombosis, stroke and hospitalization for heart failure. The impact of RAAS inhibitors on all-cause mortality alone was also evaluated. Results: During the observation period with 366 days of a median follow-up, Kaplan-Meier analysis revealed that the ARB group had the lowest rate of MACCE than other two groups (Log-rank for trend, p&lt; for < 0.0001, Figure). Regarding all-cause mortality, the ARB group and ACEi group had comparable rates for MACCE, which were lower than the no-ACEi/ARB group (p&lt; for < 0.0001). In a Cox regression analysis, after adjusting with age, gender, comorbidities, multivessel disease, acute myocardial infarction, and medications at discharge including dual antiplatelet therapy and statins, ARB therapy was still had a superiority to ACEi therapy regarding with MACCE (hazard ratio: 0.54, 95% confidence interval: 0.30-0.98). Conclusion: In the multicenter cohort study, ARB therapy was associated with better one-year clinical outcomes compared to ACEi therapy in patients undergoing PCI.

scholarly journals Continued In-Hospital Angiotensin-Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Use in Hypertensive COVID-19 Patients Is Associated With Positive Clinical Outcome

2020 ◽  
Vol 222 (8) ◽  
pp. 1256-1264 ◽  
Author(s):  
Katherine W Lam ◽  
Kenneth W Chow ◽  
Jonathan Vo ◽  
Wei Hou ◽  
Haifang Li ◽  
...  
Keyword(s):  
Angiotensin Ii ◽  
Angiotensin Converting Enzyme ◽  
Odds Ratio ◽  
Enzyme Inhibitor ◽  
Laboratory Data ◽  
Admission Rate ◽  
Angiotensin Ii Receptor Blocker ◽  
Converting Enzyme ◽  
Angiotensin Ii Receptor ◽  
Icu Admission

Abstract Background This study investigated continued and discontinued use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB) during hospitalization of 614 hypertensive laboratory-confirmed COVID-19 patients. Methods Demographics, comorbidities, vital signs, laboratory data, and ACEi/ARB usage were analyzed. To account for confounders, patients were substratified by whether they developed hypotension and acute kidney injury (AKI) during the index hospitalization. Results Mortality (22% vs 17%, P &gt; .05) and intensive care unit (ICU) admission (26% vs 12%, P &gt; .05) rates were not significantly different between non-ACEi/ARB and ACEi/ARB groups. However, patients who continued ACEi/ARBs in the hospital had a markedly lower ICU admission rate (12% vs 26%; P = .001; odds ratio [OR] = 0.347; 95% confidence interval [CI], .187–.643) and mortality rate (6% vs 28%; P = .001; OR = 0.215; 95% CI, .101–.455) compared to patients who discontinued ACEi/ARB. The odds ratio for mortality remained significantly lower after accounting for development of hypotension or AKI. Conclusions These findings suggest that continued ACEi/ARB use in hypertensive COVID-19 patients yields better clinical outcomes.

Prognostic effect of angiotensin-converting-enzyme inhibitors (ACEI) and diuretics in patients with pancreatic cancer.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 420-420 ◽  
Author(s):  
Humaid Obaid Al-Shamsi ◽  
Akram Shalaby ◽  
Aneeqa Yousaf Dar ◽  
Manal Hassan ◽  
Robert A. Wolff ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Angiotensin Converting Enzyme ◽  
Enzyme Inhibitor ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Cancer Center ◽  
Prior History ◽  
Converting Enzyme ◽  
Antihypertensive Medications ◽  
All Cause Mortality

420 Background: Prior history of chronic medical conditions and medical treatment exposure has been significantly associated with the development and prognosis of different cancers. Population-based studies reported a reduced cancer-related mortality among patients with pancreatic cancer who were Statin or Metformin users as compared with non-users. We aimed to study the effect of antihypertensive medications on the survival outcome of pancreatic cancer. Methods: Under institutional ethical approval, medical records were reviewed and clinical characteristics at baseline (time of diagnosis) were retrieved. Blood pressure and antihypertensive medications use were documented including Angiotensin Converting Enzyme Inhibitor (ACEI), diuretics, Angiotensin Receptor Blockers (ARBs) and Beta-Blockers (BB). Hazard ratios (HRs) and 95% CIs were calculated by using Cox proportional hazard models with a backward stepwise selection procedure to identify independent prognostic factors for overall survival. Results: A total of 1,204 patients with adenocarcinoma of the pancreas were diagnosed at MD Anderson Cancer center between 1999 and 2009 were identified. The mean age value (± SD) is 61.9± 10 where 58.6% (N=705) were men and 87.5% (N=1,054) were white. The majority of patients were Caucasian (87%). 41.9% had metastatic disease. A total of 639 (53%) patients had chemotherapy with or without radiation. ACEI and diuretics use independently reduced all-cause mortality, ACEI by 24% with HR 0.76 (CI 0.63-0.91), and diuretics by 26% with HR 0.73 (CI 0.60- 0.89). Neither ARBs nor beta blockers use was statistically significant in reducing all-cause mortality (HR.80, CI 0.63 -1.0), BB HR 0.85 (CI 0.7-1.0). Conclusions: Our findings indicate a significant impact of anti-hypertensive medications including ACEI and diuretics on pancreatic cancer outcomes with improved survival in users versus non-users, this effect was independent of the cancer treatment received, tumour histology and site of metastasis. The potential antitumor activities of these agents in pancreatic cancer should be studied further.

scholarly journals Could Anti‐Hypertensive Drug Therapy Affect the Clinical Prognosis of Hypertensive Patients With COVID‐19 Infection? Data From Centers of Southern Italy

2020 ◽  
Vol 9 (17) ◽  
Author(s):  
Celestino Sardu ◽  
Paolo Maggi ◽  
Vincenzo Messina ◽  
Pasquale Iuliano ◽  
Antonio Sardu ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Angiotensin Converting Enzyme ◽  
Enzyme Inhibitor ◽  
Angiotensin Receptor Blockers ◽  
Converting Enzyme ◽  
Angiotensin Receptor ◽  
Angiotensin Converting Enzyme 2 ◽  
Receptor Blockers ◽  
Worse Prognosis

BACKGROUND Coronavirus disease 2019 (COVID‐19) is the cause of a pandemic disease, with severe acute respiratory syndrome by binding target epithelial lung cells through angiotensin‐converting enzyme 2 in humans. Thus, patients with hypertension with COVID‐19 could have worse prognosis. Indeed, angiotensin‐converting enzyme inhibitors and/or angiotensin receptor blockers may interfere with angiotensin‐converting enzyme 2 expression/activity. Thus, patients with hypertension undergoing angiotensin‐converting enzyme inhibitor and/or angiotensin receptor blockers drug therapy may be at a higher risk of contracting a serious COVID‐19 infection and should be monitored. Moreover, in the present study we investigated the effects of angiotensin‐converting enzyme inhibitor versus angiotensin receptor blockers versus calcium channel blockers on clinical outcomes as mechanical ventilation, intensive care unit admissions, heart injury, and death in 62 patients with hypertension hospitalized for COVID‐19 infection. METHODS AND RESULTS The multicenter study was prospectively conducted at Department of Infectious Diseases of Sant'Anna Hospital of Caserta, and of University of Campania "Luigi Vanvitelli" of Naples, at Department of Advanced Surgical and Medical Sciences of University of Campania "Luigi Vanvitelli," Naples, and at General Medical Assistance Unit "FIMG," Naples, Italy. Lowest values of left ventricle ejection fraction predicted deaths (1.142, 1.008–1.294, P <0.05), while highest values of interleukin‐6 predicted the admission to intensive care unit (1.617, 1.094–2.389), mechanical ventilation (1.149, 1.082–1.219), heart injuries (1.367, 1.054–1.772), and deaths (4.742, 1.788–8.524). CONCLUSIONS Anti‐hypertensive drugs didn't affect the prognosis in patients with COVID‐19. Consequently, tailored anti‐inflammatory and immune therapies in addition to chronic antihypertensive therapy, could prevent a worse prognosis, as well as improve the clinical outcomes in patients with hypertension with COVID‐19 infection.

scholarly journals Correlation between anti-hypertensive drugs and disease progression among moderate, severe, and critically ill COVID-19 patients in the second referral hospital in Surbaya: A retrospective cohort study

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 393
Author(s):  
Satriyo Dwi Suryantoro ◽  
Mochammad Thaha ◽  
Mutiara Rizky Hayati ◽  
Mochammad Yusuf ◽  
Budi Susetyo Pikir ◽  
...  
Keyword(s):  
Cohort Study ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Angiotensin Converting Enzyme ◽  
Disease Progression ◽  
Critically Ill ◽  
Angiotensin Receptor Blockers ◽  
Converting Enzyme ◽  
Converting Enzyme Inhibitors ◽  
Icu Admission

Background: Hypertension, as the comorbidity accompanying COVID-19, is related to angiotensin-converting enzyme 2 receptor (ACE-2R) and endothelial dysregulation which have an important role in blood pressure regulation. Other anti-hypertensive agents are believed to trigger the hyperinflammation process. We aimed to figure out the association between the use of anti-hypertensive drugs and the disease progression of COVID-19 patients.   Methods: This study is an observational cohort study among COVID-19 adult patients from moderate to critically ill admitted to Universitas Airlangga Hospital (UAH) Surabaya with history of hypertension and receiving anti-hypertensive drugs.   Results: Patients receiving beta blockers only had a longer length of stay than angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ACEI/ARB) or calcium channel blockers alone (17, 13.36, and 13.73 respectively), had the higher rate of intensive care unit (ICU) admission than ACEi/ARB (p 0.04), and had the highest mortality rate (54.55%). There were no significant differences in length of stay, ICU admission, mortality rate, and days of death among the single, double, and triple anti-hypertensive groups. The mortality rate in groups taking ACEi/ARB was lower than other combination.   Conclusions: Hypertension can increase the severity of COVID-19. The use of ACEI/ARBs in ACE-2 receptor regulation which is thought to aggravate the condition of COVID-19 patients has not yet been proven. This is consistent with findings in other anti-hypertensive groups.

scholarly journals Onset of Hyperkalemia following the Administration of Angiotensin-Converting Enzyme Inhibitor or Angiotensin II Receptor Blocker

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Hye-Ran Jun ◽  
Hyunah Kim ◽  
Seung-Hwan Lee ◽  
Jae Hyoung Cho ◽  
Hyunyong Lee ◽  
...  
Keyword(s):  
Angiotensin Ii ◽  
Angiotensin Converting Enzyme ◽  
Angiotensin Converting Enzyme Inhibitor ◽  
Enzyme Inhibitor ◽  
Hospitalized Patients ◽  
Receptor Blocker ◽  
Angiotensin Ii Receptor Blocker ◽  
Converting Enzyme ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitor

Introduction. In spite of the established importance of detecting angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker- (ARB-) induced hyperkalemia, there have not been many studies on the time of its occurrence. Methods. We retrospectively analyzed electronic medical records to determine the onset time and incidence rate of hyperkalemia ( serum   potassium > 5.5   mEq / L or 6.0 mEq/L) among hospitalized patients newly started on a 15-day ACEI or ARB therapy. Results. Among 3101 hospitalized patients, hyperkalemia incidence was 0.5%–0.9% and 0.8%–2.1% in the ACEI and ARB groups, respectively. However, it was not significantly different among different ARB types. Hyperkalemia’s onset was distributed throughout 15 days, without any trend. Hyperkalemia incidence was 7.3 and 35.1 times higher at 5.5 mEq/L ( hazard   ratio   HR = 7.31 , 95 % confidence   interval   CI = 4.19 – 12.76 , p < 0.001 ) and 6.0 mEq/L ( HR = 35.11 , 95 % CI = 8.25 – 149.52 , p < 0.001 ), respectively, than the baseline creatinine level. Hyperkalemia incidence in patients with chronic renal failure was 5.7 and 9.2 times higher at 5.5 mEq/L ( HR = 5.72 , 95 % CI = 3.24 – 10.12 , p < 0.001 ) and 6.0 mEq/L ( HR = 9.16 , 95 % CI = 4.02 – 20.88 , p < 0.001 ), respectively. Conclusions. It is unlikely that it is necessary to monitor hyperkalemia immediately after administration of ACEI or ARB. However, when prescribed for patients with abnormal kidney function, clinicians should always consider the possibility of developing hyperkalemia.

Abstract 16726: Impact of Angiotensin Converting Enzyme Inhibitors/angiotensin Receptor Blockers on Mortality and Severity of Covid-19 Pneumonia

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ankita Aggarwal ◽  
Anubhav Jain ◽  
Mishita Goel ◽  
Jurgena Tusha ◽  
Verisha Khanam ◽  
...  
Keyword(s):  
Angiotensin Converting Enzyme ◽  
Hospital Stay ◽  
Angiotensin Receptor Blockers ◽  
Length Of Hospital Stay ◽  
P Value ◽  
Target Cells ◽  
Converting Enzyme ◽  
Converting Enzyme Inhibitors ◽  
Icu Admission ◽  
Total Length

Introduction: Coronaviruses are a large family of viruses that have been around for many years and may cause illness in humans or animals. In early December 2019, the first pneumonia cases related to the coranoavirus were found which has since led a pandemic. Coronaviruses bind to their target cells through angiotensin-converting enzyme 2 (ACE2), which is expressed by epithelial cells of the lung, intestine, kidney, and blood vessels. Hypothesis: Hypothetically, the increased expression of ACE2 would facilitate infection with COVID-19 and treatment with ACE2-stimulating drugs may worsen the infection with COVID-19. The goal of this study was to analyze the severity of COVID-19 in patients who are on ACEi and ARB therapy. Methods: All adult patients admitted with the confirmed diagnosis of COVID 19 pneumonia between March to April 2020 in our community hospital were included in the study. Patients were then be divided into two groups, one group who received ACEi or ARBs and a second group who did not. The baseline characteristics of two groups were compared. Primary outcome was the in-hospital mortality between two groups. Secondary outcomes were severity of pneumonia including rate of intubation, requirement for ICU admission and total length of hospital stay. Results: A total of 200 patients were admitted with the time frame studied. After removing for missing data 194 patients were included in the study of which 64 patients received either ACEi or ARB during the hospital stay. There was no difference in the rate of inpatient mortality in patients who received or did not received the drug (32.3% vs 23.5% p- value 0.19). Similarly, there was no difference in the other outcomes including rate of intubation(22.6% vs 24.4% p- value 0.79), requirement for ICU admission(21% vs 33.3% p-value 0.07) and mean total length of hospital stay between the two groups (9.5 days vs 8.4 days p-value 0.34). Conclusion: There was no difference in the outcomes. Patients who received ACEi or ARBs did not have worse outcomes. Thus, if indicated for other reasons, these drugs can safely be continued in patients with COVID 19 pneumonia. Further large center studies are however, required to confirm our findings.

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