Inpatient Omission of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Is Associated With Morbidity and Mortality in Coronavirus Disease 2019

Abstract

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Treating COVID-19: Targeting the Host Response, Not the Virus

“…The importance of statin withdrawal and its probable mechanisms of action were extensively reviewed in 2006 [ 181 ]. For COVID-19, similar findings have been published for ACE inhibitor and ARB withdrawal [ 164 , 165 , 166 , 167 , 168 ].…”

“…A clinical trial of telmisartan (an ARB) has yielded similar results [ 162 ]. Moreover, continuation of ACE inhibitor/ARB outpatient treatment after hospitalization has beneficial effects on COVID-19 outcomes [ 163 ], whereas discontinuing treatment can be harmful [ 164 , 165 , 166 , 167 , 168 ]. Similarly, an increase in COVID-19 mortality has been observed following withdrawal of statin treatment [ 169 , 170 ].…”

Increased complications of COVID-19 in people with cardiovascular disease: Role of the renin–angiotensin-aldosterone system (RAAS) dysregulation

“…Global healthcare, cardiology departments, and health authorities recommend continuing RAAS inhibitor treatment of COVID-19 patients because of their proven anti-hypertensive activity and lack of evidence towards of harm to affected patients [ 198 , 199 ]. Several retrospective studies also reported that ICU requirements and COVID-19 death rates were inversely related to ACEIs/ARBs treatment in hypertensive, non-hypertensive and elderly patients [ [200] , [201] , [202] , [203] ]. As there is conflicting evidence regarding the role of ACEIs/ARB in COVID-19 susceptibility and outcomes, further studies should be performed in this direction by considering multiple factors related to ACEIs/ARB-associated ACE2 expression and level of Angiotensin II in such patients with and without COVID-19 [ 204 ].…”

RAAS, ACE2 and COVID-19; a mechanistic review

“…Another retrospective study reported that the provision of ACEIs/ARBs in the intensive care unit (ICU) for COVID-19 elderly patients was associated with a marked reduction in the mortality rates ( Oddy et al, 2021 ).…”