Possible Benefit of Angiotensin II Receptor Blockers in COVID-19 Patients: A Case Series

Abstract

Introduction. Dysfunction in the renin-angiotensin-aldosterone system (RAAS) has been observed in patients with coronavirus disease 2019 (COVID-19). It is presumed that the effect of reducing interleukin-6 (IL-6) levels by angiotensin II receptor blockers (ARBs) by RAAS modulation. We investigated changes in angiotensin II and IL-6 levels in four COVID-19 patients treated with ARBs. Case Presentation. Cases 1 and 2 were who had not received ARBs before and were newly administered ARBs. Case 3 restarted ARBs after discontinuation for 7 days, and case 4 received an increased dose of ARBs. The mean in angiotensin II levels (607.5 pg/mL, range: 488–850 pg/mL, reference range < 100 pg / mL ), C-reactive protein (CRP) (10.58 mg/dL, range 4.45-18.05 mg/dL), and IL-6 (55.78 pg/mL, range: 12.86–144.82 pg/mL, reference range < 7 pg / mL ) was observed at the admission in all patients. Upon clinical improvement, the mean decrease in CRP (1.02 mg/dL, range 0.06-3.78 mg/dL) and IL-6 (5.63 pg/mL, range 0.17-20.87 pg/mL) was observed in all patients. Conversely, angiotensin II levels gradually increased. Conclusion. This report supports the potential benefit of ARBs to improve the clinical outcomes of COVID-19 patients by controlling RAAS dysfunction.

Lack of Correlation Between Soluble Angiotensin-Converting Enzyme 2 and Inflammatory Markers in Hospitalized COVID-19 Patients with Hypertension

“… 43 A case series presented by Lee et al also indicated that patients treated with ARBs had reduced CRP following clinical improvement. 44 …”

“…43 A case series presented by Lee et al also indicated that patients treated with ARBs had reduced CRP following clinical improvement. 44 Studies have demonstrated that the level of CRP measured upon admission is a straightforward and independent indicator that could be helpful for the early diagnosis of severity during COVID-19. 45,46 Yet; several studies suggested that rather than a single parameter, multiple markers should be used as predictors of severity and mortality in patients with COVID-19.…”

New Perspectives for Antihypertensive Sartans as Components of Co-crystals and Co-amorphous Solids with Improved Properties and Multipurpose Activity

“…Twenty two of these studies have already been completed. Some of the studies suggested reconsideration of ARBs in the treatment of COVID-19 patients and highlight the potential beneficial role of ARBs to improve the clinical outcomes of COVID-19 patients by controlling the RAAS (Renin-Angiotensin-Aldosterone System) dysfunction. , Other studies confirm safety of the ARBs treatment in COVID-19 patients − this type of uncertainty suggesting that ARBs may worsen the condition of patients with COVID-19 arose at the beginning of the pandemic and has been refuted. In addition to clinical trials, molecular docking studies have also been conducted to demonstrate the potential of ARBs to inhibit the COVID-19 main proteasethe best results were obtained for fimasartan and candesartan …”

The Relationship Between Covid-19 Severity and the Usage of Angiotensin-Ii Receptor Blockers in Hypertensive Patients

“…Furthermore, a meta-analysis of twenty-six studies involving 8,104 hypertensive ACEI/ARB users and 8,203 hypertensive non-ACEI/ARB users reported a significantly lower mortality risk and a lower need for ventilator use among ACEI/ARB users (Wang et al, 2021). Another study showed the possible benefit of ARBs in COVID-19 patients through a case series (Lee et al, 2021). There has been no studies regarding this in Bangladesh.…”