Risk of severe COVID-19 in hypertensive patients treated with renin-angiotensin-aldosterone system inhibitors

Golpe, Rafael; Pérez-de-Llano, Luis; Dacal, David; Guerrero-Sande, Héctor; Pombo-Vide, Beatriz; Ventura-Valcárcel, Pablo

doi:10.1016/j.medcle.2020.06.028

Cited by 5 publications

(3 citation statements)

References 10 publications

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“…Among the seven studies, four involved US patients, three enrolled Europeans while none was from China. 8,17,18,33,39,40,55 Country-specific subgroup and sensitivity analysis showed a nearly 4 times higher risk of hospitalization in US patients [pooled OR 3.87 (1.21–12.34), I 2 = 97%] while no such risk was evident in Europeans [pooled OR 2.07 (0.87–4.92), I 2 = 97%] (Supplemental Figure 4 and Table 2).…”

Section: Resultsmentioning

confidence: 99%

Renin–angiotensin–aldosterone system blockers and region-specific variations in COVID-19 outcomes: findings from a systematic review and meta-analysis

Kaur

Chakrabarti

Patel

2021

Therapeutic Advances in Drug Safety

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Background and aims: Coronavirus disease 2019 (COVID-19) has been observed to cause a high mortality in people with cardiometabolic diseases. Renin–angiotensin–aldosterone system (RAAS) blockers enhance the expression of ACE2, the binding receptor of SARS-CoV-2, and can enhance viral infectivity. We aim to provide a pooled estimate of the effect of RAAS blockers on COVID-19 outcomes. Methods: A literature search was performed using MEDLINE/PubMed, Google Scholar and preprint servers. All clinical studies analyzing the effect of RAAS blockers on clinical outcomes in COVID-19 patients were included in this study. Newcastle–Ottawa scale was used for quality assessment of studies. MOOSE checklist was followed. Mortality and severity outcomes were recorded as pooled odds ratio (OR) with 95% Confidence Intervals (CIs) and level of heterogeneity ( I2). Odds of mortality was the primary outcome. Odds of severity, hospitalization, intensive care unit (ICU) admission, mechanical ventilation (MV), steroid use and acute kidney injury were the secondary outcomes. Severity outcomes were chosen depending upon the definition used by respective authors. Country-specific variations and effects of individual class of RAAS blockers were also explored. Results: In total 47 published studies were included in the final analysis, with a total of 26,432 patients from 31 studies in mortality analysis and 20,127 patients from 23 studies in severity analysis. No increased risk of mortality [Pooled OR 0.91 (0.65–1.26), I2 = 89%] or severity [Pooled OR 1.08 (0.79–1.46), I2 = 88%] was seen with RAAS blockers. The drug class was protective in hypertension [pooled OR 0.63 (0.46–0.86), I2 = 58%]. Severity of COVID-19 outcomes was high for Europeans [Pooled OR 2.08 (1.52–2.85), I2 = 77%] and US patients [Pooled OR 1.87 (1.62–2.17)]. Nearly 4 times higher risk of hospitalization and 2 times higher risk of ICU admission and MV were observed in US patients. Class-wise, angiotensin receptor blocker use was associated with 1.6 times higher odds of severity, mainly in Europeans. Conclusion: RAAS blockers are not associated with increased mortality in COVID-19 patients and should be continued in hypertensives. US and European patients are at higher risk of severe outcomes. Pharmacogenetic differences may explain the ethnicity-related variations. Plain language summary Effect of RAAS-blocking medicines on COVID-19 Background and aims: Higher deaths have been observed in COVID-19 patients who have other long-term diseases such as heart disease, diabetes, and high blood pressure. Many of these patients are prescribed a class of medicines called RAAS blockers (ramipril, telmisartan, etc). We studied whether the use of these medicines worsens the course of COVID-19 disease in these patients or causes excess deaths. Methods: We conducted a pooled analysis of 47 observational studies on the use of RAAS blocker drugs in COVID-19 patients. Results: We found that RAAS blockers do not cause excess deaths in patients with COVID-19. On the contrary, they have benefits if prescribed to those with high blood pressure. We also found that whereas European and US patients of COVID-19 taking these medicines had higher disease severity, this was not the case for Chinese patients. Conclusion: Theremay be some genetic and other factors responsible for differences by ethnicity.

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Section: Resultsmentioning

confidence: 99%

Renin–angiotensin–aldosterone system blockers and region-specific variations in COVID-19 outcomes: findings from a systematic review and meta-analysis

Kaur

Chakrabarti

Patel

2021

Therapeutic Advances in Drug Safety

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“…Thus far, studies have not shown any significant association between ACEIs and ARBs and the odds of SARS-CoV-2 infection or developing severe COVID-19 symptoms, and this finding is consistent with a meta-analysis of PubMed, Google Scholar, EMBASE, and various preprint servers of COVID-19 clinical outcomes that similarly showed no increased risks of using antihypertensive medications during the management of COVID-19. 69–72 While the risk of COVID-19 susceptibility is elevated in patients with HTN, treatment with ACEIs and ARBs should not be discontinued as of this point. However, further investigation with larger randomized control trials regarding the expression of ACE2 and susceptibility to SARS-CoV-2 is still required.…”

Section: Considerations For Management Of Covid-19 Patients With Card...mentioning

confidence: 99%

Coronavirus Disease 2019 and Cardiometabolic Disease

Kim

Aronow

Frishman

2021

Cardiology in Review

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Cardiometabolic disease describes a combination of metabolic abnormalities that increases the risk of type 2 diabetes and cardiovascular diseases, including pathological changes such as insulin resistance, hyperglycemia, dyslipidemia, abdominal obesity, and hypertension, and environmental risk factors such as smoking, sedentary lifestyle, poor diet, and poverty. As the number of coronavirus disease 2019 (COVID-19) patients continues to rise, type 2 diabetes, cardiovascular disease, hypertension, and obesity, all components of, or sequelae of cardiometabolic disease, were identified among others as key risk factors associated with increased mortality in these patients. Numerous studies have been done to further elucidate this relationship between COVID-19 and cardiometabolic disease. Cardiometabolic disease is associated with both increased susceptibility to COVID-19 and worse outcomes of COVID-19, including intensive care, mechanical ventilation, and death. The proinflammatory state of cardiometabolic disease specifically obesity, has been associated with a worse prognosis in COVID-19 patients. There has been no evidence to suggest that antihypertensives and antidiabetic medications should be discontinued in COVID-19 patients but these patients should be closely monitored to ensure that their blood pressure and blood glucose levels are stable. Assessment of vaccination efficacy in cardiometabolic disease patients is also discussed.

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“…Age is reported as the main risk factor for COVID-19 (Dariya and Nagaraju, 2020; Díaz de León-Martínez et al, 2020; Erener, 2020; Freeman et al, 2020; Golpe et al, 2020; Leung, 2020; Li et al, 2020; Memtsoudis et al, 2020). Based on the reported COVID-19 cases in the United States (Razzaghi, 2020): 31% of cases, 45% of hospitalizations, 53% of ICU admissions, and 80% of deaths occurred among adults aged ≥65 years.…”

Section: Covid-19 Risk Factorsmentioning

confidence: 99%

Risk assessment of COVID-19 based on a new structure of neural fuzzy probabilistic model

Sabahi

2021

Transactions of the Institute of Measurement and Control

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The risk assessment of the COVID-19 infection can save so many lives, reduce treatment costs, and increase public health. The unknown nature of the COVID-19 infection, the high impreciseness of available information, and not simply recognizing the relevant factors and their effectiveness may cause overestimating and underestimating of factors. This paper puts forward a development of a model with fewer limitations that are more consistent with progressive knowledge about COVID-19. Dealing with the situation of updating the statistical dataset daily, the proposed approach can effectively use the subjectivity inherent in the fuzzy probability interpretation of risk factors using expert knowledge in addition to the statistical dataset. Second, to this uncertainty handling improvement, a specificity-based parameter learning based on the learning network is also added to deal with the complexity aspect of the COVID-19 infection. The learning process helps the proposed structure better adjust the effectiveness of factors. From the achieved results, it is verified that people with advanced age, those with chronic obstructive pulmonary disease, lung cancer, and those having cancer treatments are at higher risk of death if they are infected by COVID-19. Undoubtedly, for vaccination, these three groups should be considered in order to prevent death situations.

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Risk of severe COVID-19 in hypertensive patients treated with renin-angiotensin-aldosterone system inhibitors

Cited by 5 publications

References 10 publications

Renin–angiotensin–aldosterone system blockers and region-specific variations in COVID-19 outcomes: findings from a systematic review and meta-analysis

Renin–angiotensin–aldosterone system blockers and region-specific variations in COVID-19 outcomes: findings from a systematic review and meta-analysis

Coronavirus Disease 2019 and Cardiometabolic Disease

Risk assessment of COVID-19 based on a new structure of neural fuzzy probabilistic model

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