Efficacy of ACEIs/ARBs vs CCBs on the progression of COVID‐19 patients with hypertension in Wuhan: A hospital‐based retrospective cohort study

Abstract

Background To evaluate the efficacy of angiotensin‐converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) versus calcium channel blockers (CCBs) on the progression of COVID‐19 patients with hypertension in Wuhan. Methods This retrospective single‐center case series analyzed COVID‐19 patients with hypertension, treated with ACEIs/ACEIs or CCBs at the Tongji Hospital of Wuhan City, Chin from January 25th to March 15th, 2020. After PSM analysis, 76 patients were selected into two groups. Univariate and multivariable analyses were conducted to determine factors related to improvement measures and outcome measures by Cox proportional hazard regression models. Results Among 157 patients with confirmed COVID‐19 combined hypertension, including 73 males and 84 females, a median age of 67.28 ±9.11 vs 65.39 ±10.85 years. A univariable analysis indicated that clinical classification, lymphp cyte count and interleukin‐2 receptor were associated with a lengthened negative time of nucleic acid, with a significant difference between two groups (p=0.036). Furthermore, we found no obvious difference in nucleic acid conversion time between ACEIs/ARBs group and CCBs group (HR 0.70, 95% CI [0.97, 3.38], p=0.18) in the multivariable analysis as well as chest CT improved time (HR 0.73, 95% CI [0.45, 1.2], p=0.87), and hospitalization time between ACEIs/ARBs group and CCBs group (HR 1.06, 95% CI [0.44, 1.1], p=0.83). Conclusion Our study provided additional evidence of no obvious difference in progress and prognosis between ACEIs/ACEIs and CCBs group, which may suggest ACEIs/ARBs may have scarcely influence on increasing the clinical severe situations of COVID‐19 patients with hypertension. This article is protected by copyright. All rights reserved.

Association Between Renin-Angiotensin-Aldosterone System Inhibitors and Clinical Outcomes in Patients With COVID-19

“…Most studies included in the meta-analysis were retrospective 20 , 21 , 33 , 44 or observational 4 , 6 , 26 , 37 , 61 , 62 , 63 and were conducted in China, 4 , 8 , 10 , 23 , 24 , 25 , 28 , 31 , 32 , 35 , 39 , 41 , 45 , 48 , 55 , 58 , 59 , 60 , 62 , 64 , 65 , 66 Europe, 5 , 7 , 9 , 18 , 19 , 22 , 30 , 34 , 40 , 43 , 46 , 47 , 51 , 52 , 53 , 56 , 57 or North America. 6 , 20 , 49 , 50 , 54 Two studies 22 , 38 included a subgroup of patients receiving ACEIs/ARBs that were explicitly discontinued during hospital admission.…”

Mortality and Severity in COVID-19 Patients on ACEIs & ARBs - A Meta-Regression Analysis

“…Of the comorbidities considered, 25.4% were diabetics, 16.6% had heart diseases overall. Similarly, a total of forty three studies 29,31,33,36-38,41,43,45-47,49,53,55-57,59-61,64-66,69,73,74,76,77,79,82-96 were included for meta-analysis for the secondary outcome i.e. severity of disease.…”

Viruses and Endogenous Retroviruses as Roots for Neuroinflammation and Neurodegenerative Diseases

“…Viruses can infect endothelial cells of the BBB, allowing viral replicates to be released into the CNS (Verma et al, 2009;Fletcher et al, 2012), while infection of leukocytes or monocytes by, for example, HIV and SARS-CoV-2, that pass BBB physiologically, provides a "trojan-horse" mechanism to enter the CNS (Larochelle et al, 2011;Takeshita and Ransohoff, 2012;Bostanciklioglu, 2020). Attention is currently drawn to the CNS invasion through retrograde neuronal transport of infected peripheral nerve afferents, as SARS-CoV-2 and other coronaviruses are associated with CNS entry via the olfactory pathway, a mechanism that has been also described for other viral families such as influenza A virus, rabies virus, and herpesviruses (van Riel et al, 2015), and other peripheral nerves, for example, the sciatic nerve and vagus nerve (Ren and Racaniello, 1992;Ohka et al, 1998;Guadarrama-Ortiz et al, 2020;Liu et al, 2020). Figure 1 depicts the mechanisms of viral entry into the CNS.…”

“…These include most frequently Guillain Barré syndrome but also Miller Fisher syndrome, polyneuritis cranialis, acute myelitis, oculomotor paralysis, and Bell's palsy have been reported (Guadarrama-Ortiz et al, 2020;Katyal et al, 2020). SARS-CoV-2 uses the olfactory nerves and possibly the vagus nerve to access the brain (Guadarrama-Ortiz et al, 2020;Liu et al, 2020) where ACE2 receptor is expressed on neurons and glial cells (Zou et al, 2020). The neuromuscular invasion of SARS-CoV-2 likely involves retrograde axonal transfer of the virus in trans-synaptic pathway and cytokine storm (Katyal et al, 2020).…”