Benefits and Risks of Continuing Angiotensin-Converting Enzyme Inhibitors, Angiotensin II Receptor Antagonists, and Mineralocorticoid Receptor Antagonists during Hospitalizations for Acute Heart Failure

Oliveros, Estefanía; Oni, Ebenezer; Shahzad, Anum; Kluger, Aaron Y.; Lo, Kevin Bryan; Rangaswami, Janani; McCullough, Peter A.

doi:10.1159/000504167

Cited by 29 publications

(22 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, withdrawal of these inhibitors may be harmful in some high-risk patients with proven or suspected COVID-19. Consistent with the present guidelines, patients with hypertension or chronic kidney disease should keep taking antihypertensive drugs as administered by the physician without interruption because this action increases the readmission probability to hospitals and mortality rates in patients with heart and kidney failure [15,16]. Considering the equal efficacy but much lower side effects, ARBs may be used more favorably in patients who are at a higher risk of developing severe COVID-19.…”

Section: Angiotensin II Receptorsmentioning

confidence: 86%

JAK Inhibition as a New Treatment Strategy for Patients with COVID-19

Seif

Aazami

Khoshmirsafa

et al. 2020

Int Arch Allergy Immunol

182

197

View full text Add to dashboard Cite

After the advent of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the outbreak of coronavirus disease 2019 (COVID-19) commenced across the world. Understanding the Immunopathogenesis of COVID-19 is essential for interrupting viral infectivity and preventing aberrant immune responses before a vaccine can be developed. In this review, we provide the latest insights into the roles of angiotensinconverting enzyme II (ACE2) and Ang II receptor-1 (AT1-R) in this disease. Novel therapeutic strategies, including recombinant ACE2, ACE inhibitors, AT1-R blockers, and Ang 1-7 peptides, may prevent or reduce viruses-induced pulmonary, cardiac, and renal injuries. However, more studies are needed to clarify the efficacy of these therapeutics. Furthermore, considering the common role of the Janus kinase-signal transducer and activator of transcription (JAK-STAT) pathway in AT1-R expressed on peripheral tissues and cytokine receptors on the surface of immune cells, potential targeting of this pathway using JAK inhibitors (JAKinibs) is suggested as a promising approach in patients with COVID-19 who are admitted to hospitals. In addition to antiviral therapy, potential ACE2-and AT1-R-inhibiting strategies, and other supportive care, we suggest other potential JAKinibs and novel anti-inflammatory combination therapies that affect M.P. and D.M. contributed equally to this work as corresponding authors. Edited by: H.-U. Simon, Bern.

show abstract

Section: Angiotensin II Receptorsmentioning

confidence: 86%

JAK Inhibition as a New Treatment Strategy for Patients with COVID-19

Seif

Aazami

Khoshmirsafa

et al. 2020

Int Arch Allergy Immunol

182

197

View full text Add to dashboard Cite

show abstract

“…This finding is also clinically relevant in the context of reported data on clinical outcomes with the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB) in patients with COVID-19 [ 8 , 19 , 20 ]. Similarly, the premature discontinuation of ACE inhibitors or ARBs in heart failure patients in the absence of hemodynamic deterioration or severe hyperkalemia is associated with harm [ 21 ]. In our study, ACE/ARB use was not associated either AKI or inpatient death.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Outcomes of Community- and Hospital-Acquired Acute Kidney Injury with COVID-19 in a US Inner City Hospital System

Pelayo

Bhargav

et al. 2020

Cardiorenal Med

Self Cite

View full text Add to dashboard Cite

Introduction: Emerging data have described poor clinical outcomes from infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) among African American patients and those from underserved socioeconomic groups. We sought to describe the clinical characteristics and outcomes of acute kidney injury (AKI) in this special population. Methods: This is a retrospective study conducted in an underserved area with a predominance of African American patients with coronavirus disease 2019 (COVID-19). Descriptive statistics were used to characterize the sample population. The onset of AKI and relation to clinical outcomes were determined. Multivariate logistic regression was used to determine factors associated with AKI. Results: Nearly half (49.3%) of the patients with COVID-19 had AKI. Patients with AKI had a significantly lower baseline estimated glomerular filtration rate (eGFR) and higher FiO 2 requirement and D-dimer levels on admission. More subnephrotic proteinuria and microhematuria was seen in these patients, and the majority had a pre-renal urine electrolyte profile. Patients with hospital-acquired AKI (HA-AKI) as opposed to those with community-acquired AKI (CA-AKI) had higher rates of in-hospital death (52 vs. 23%, p = 0.005), need for vasopressors (42 vs. 25%, p = 0.024), and need for intubation (55 vs. 25%, p = 0.006). A history of heart failure was significantly associated with AKI after adjusting for baseline eGFR (OR 3.382, 95% CI 1.121-13.231, p = 0.032). Conclusion: We report a high burden of AKI among underserved COVID-19 patients with multiple comorbidities. Those who had HA-AKI had worse clinical outcomes compared to those who with CA-AKI. A history of heart failure is an independent predictor of AKI in patients with COVID-19.

show abstract

“…This postulated positive effects on lung can be also protective during overwhelming infection with COVID-19. v. Indiscriminate discontinuation of RASB in patients with heart failure may also lead to readmission to hospital and increase in mortality [45].…”

Section: Effects Of Ace Inhibitors and Angiotensin Receptor Blockersmentioning

confidence: 99%

Comorbidities in COVID-19: Outcomes in hypertensive cohort and controversies with renin angiotensin system blockers

Singh

Gupta

Misra

2020

Diabetes & Metabolic Syndrome: Clinical Research & Revi

222

156

View full text Add to dashboard Cite

a b s t r a c tBackground and aims: COVID-19 is already a pandemic. Emerging data suggest an increased association and a heightened mortality in patients of COVID-19 with comorbidities. We aimed to evaluate the outcome in hypertensive patients with COVID-19 and its relation to the use of renin-angiotensin system blockers (RASB). Methods: We have systematically searched the medical database up to March 27, 2020 and retrieved all the published articles in English language related to our topic using MeSH key words. Results: From the pooled data of all ten available Chinese studies (n ¼ 2209) that have reported the characteristics of comorbidities in patients with COVID-19, hypertension was present in nearly 21%, followed by diabetes in nearly 11%, and established cardiovascular disease (CVD) in approximately 7% of patients. Although the emerging data hints to an increase in mortality in COVID-19 patients with known hypertension, diabetes and CVD, it should be noted that it was not adjusted for multiple confounding factors. Harm or benefit in COVID-19 patients receiving RASB has not been typically assessed in these studies yet, although mechanistically and plausibly both, benefit and harm is possible with these agents, given that COVID-19 expresses to tissues through the receptor of angiotensin converting enzyme-2. Conclusion: Special attention is definitely required in patients with COVID-19 with associated comorbidities including hypertension, diabetes and established CVD. Although the role of RASB has a mechanistic equipoise, patients with COVID-19 should not stop these drugs at this point of time, as recommended by various world organizations and without the advice of health care provider.

show abstract

Benefits and Risks of Continuing Angiotensin-Converting Enzyme Inhibitors, Angiotensin II Receptor Antagonists, and Mineralocorticoid Receptor Antagonists during Hospitalizations for Acute Heart Failure

Cited by 29 publications

References 55 publications

JAK Inhibition as a New Treatment Strategy for Patients with COVID-19

JAK Inhibition as a New Treatment Strategy for Patients with COVID-19

Clinical Characteristics and Outcomes of Community- and Hospital-Acquired Acute Kidney Injury with COVID-19 in a US Inner City Hospital System

Comorbidities in COVID-19: Outcomes in hypertensive cohort and controversies with renin angiotensin system blockers

Contact Info

Product

Resources

About