Renin Angiotensin system-modifying therapies are associated with improved pulmonary health

Abstract

BackgroundPulmonary diseases are often complicated and have diverse etiologies. One common factor is the lack of therapeutics available for these diseases. The goal of this study was to investigate the impact of Renin-Angiotensin System (RAS)-modifying medications on incidence and time to pulmonary complications.MethodsA retrospective analysis was conducted using claims data from a US commercial insurance company (2007–2013). The study consisted of patients with an emerging hypertension (HTN) diagnosis. Cox analysis was used to look at the effect of angiotensin converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) in this population. The events included pneumonia and influenza (infectious), Chronic obstructive pulmonary disease (COPD) and allied conditions (inflammatory), and other diseases (structural).ResultsA total of 215,225 patients were followed in the study. These fell into three groups depending on the first prescribed anti-hypertension medication; ACE-Is (47.21%), ARBs (11.40%) and calcium channel blockers (CCBs)/Diuretics-Control (41.39%). The use of ACE-I as first treatment significantly reduced the incidence of infectious (Hazard Ratio (HR) 0.886, 95% Confidence Interval (95% CI) 0.859–0.886), inflammatory (HR 0.924, 95% CI 0.906–0.942) and structural outcomes (HR 0.865, 95% CI 0.847–0.885); it also increased the time (delayed) to diagnosis with prolonged treatment. Primary ARB use only significantly lowered the incidence of structural outcomes (HR 0.900, 95% CI 0.868–0.933); prolonged treatment did reduce incidence of all three diagnosis groups and significantly delayed disease onset.ConclusionsThere is an association between the use of ACE-Is and ARBs and a delay in the progression of pulmonary complications in vulnerable populations. Research into the RAS may identify future therapies for patients with potential chronic pulmonary conditions.

Hypertension, the renin–angiotensin system, and the risk of lower respiratory tract infections and lung injury: implications for COVID-19

“…This also applies to viral pneumonia, in which RAS blockers have been associated with improved pneumonia-related outcomes. 23,24 Is hypertension associated with COVID-19 infections?…”

Improving the Innate Immune Response in Diabetes by Modifying the Renin Angiotensin System

“…A recent pharmacoeconomic analysis of the effect of inhibitors of the pathological of RAS on pulmonary infections supporting the translatability of these results to diabetic patients. Using a deidentified insurance claims data set it was shown that even newly diagnosed T2DM is associated with higher incidence of pulmonary infections and that RAS-modifying drugs can reduce these outcomes (54). Future studies will explore mechanisms by which Mas agonism improves immune function in diabetic patients and the role of other immune cells in this paradigm.…”

Renin–Angiotensin System: An Important Player in the Pathogenesis of Acute Respiratory Distress Syndrome

“…A retrospective analysis of 215,225 American patients revealed that treatment with ACEIs or ARBs slowed the progression of pulmonary complications in COPD patients [76]. The analysis of the medical records of 182 ARDS patients showed an increased survival rate in patients treated with ACEIs or ARBs [77]. The Cox regression analysis of the data obtained in the longitudinal observational Fremantle Diabetes Study Phase II, found that the use of ACEIs/ARBs was associated with a reduced risk of pneumonia/influenza in patients with type 2 diabetes mellitus [78].…”