scholarly journals Angiotensin enzyme inhibitors and angiotensin receptor blockers as protective factors in COVID-19 mortality: a retrospective cohort study

2020 ◽  
Author(s):  
Ashkan Yahyavi ◽  
Nima Hemmati ◽  
Pegah Derakhshan ◽  
Behrooz Banivaheb ◽  
Arman Karimi Behnagh ◽  
...  
Keyword(s):  
Cohort Study ◽  
Protective Factors ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Receptor ◽  
Receptor Blockers

scholarly journals Severity of COVID-19 Infection in ACEI/ARB Users in Two Saudi Public Specialty Hospitals; Retrospective Cohort Study

2020 ◽  
Author(s):  
Ahmed A. Alrashed ◽  
Tahir M. Khan ◽  
Noara K. Alhusseini ◽  
Syed Mohammed Basheeruddin Asdaq ◽  
Mushira Enani ◽  
...  
Keyword(s):  
Cohort Study ◽  
Renal Disease ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme Inhibitors ◽  
Specialty Hospitals ◽  
Patients With Diabetes

Abstract The uncertainty about COVID-19 outcomes in angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) users continues with contradictory findings. The aim of this study was to determine the effect of ACEI/ARB use in patients with severe COVID-19. This retrospective cohort study done in two Saudi public specialty hospitals designated as COVID-19 referral facilities. We included 354 patients with confirmed diagnosis of COVID-19 between April and June 2020, of which 146 were ACEI/ARB users and 208 were non-ACEI/ARB users. Controlling for confounders, we conducted a multivariate logistic regression and a sensitivity analysis using propensity score matched (PSM) patients. Compared to non-ACEI/ARB users, ACEI/ARB users had an eight-fold higher risk of developing critical or severe COVID-19 (OR=8.25, 95%CI=3.32-20.53); a nearly 7-fold higher risk of intensive care unit (ICU) admission (OR=6.76, 95%CI=2.88-15.89) and a nearly 5-fold higher risk of requiring noninvasive ventilation (OR=4.77,95%CI=2.15-10.55). Patients with diabetes, hypertension, and/or renal disease had a five-fold higher risk of severe COVID-19 disease (OR=5.40,95%CI=2.0-14.54]. These results were confirmed in the PSM analysis. In general, but especially among patients with hypertension, diabetes, and/or renal disease, ACEI/ARB use is associated with a significantly higher risk of severe or critical COVID-19 disease, and ICU care.

scholarly journals Impact of Angiotensin-converting Enzyme Inhibitors and Angiotensin Receptor Blockers on Inflammatory Responses and Viral Clearance in COVID-19 Patients: A Multicenter Retrospective Cohort Study

2020 ◽  
Author(s):  
Linna HUANG ◽  
Ziying CHEN ◽  
Lan NI ◽  
Lei CHEN ◽  
Changzhi ZHOU ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Enzyme Inhibitors ◽  
Inflammatory Responses ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Viral Clearance ◽  
Control Group ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
Receptor Blockers

Abstract Objectives: To evaluate the impact of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) on coronavirus disease 2019 (COVID-19) patients.Methods: We included 229 patients with confirmed COVID-19 in a multicenter, retrospective cohort study. Propensity score matching at a ratio of 1:4 was introduced to eliminate the potential confounders. Patients were assigned to the ACEI/ARB group (n=40) or control group (n=160) according to whether they were current users of medication. Results: Compared to the control group, patients in the ACEI/ARB group had lower levels of plasma IL-1β [(6.27±0.50) vs. (8.23±0.39) pg/ml, P=0.028], IL-8 [(35.74±4.00) vs. (45.88±2.06) pg/ml, P=0.037] and TNF-α [(8.79±0.40) vs. (10.91±0.21) pg/ml, P<0.01]. Patients with the current use of ACEIs/ARBs had a higher risk of shock (23% vs. 8%, P<0.01). Decreased lymphocyte counts [(0.85±0.45) vs. (1.02±0.52)*10^9/L, P=0.041] and elevated plasma levels of IL-10 [(7.39±0.51) vs. (6.18±0.16) pg/ml, P<0.01] were also important discoveries in the ACEI/ARB group. Patients in the ACEI/ARB group had a prolonged duration of viral shedding [(25±7) vs. (20±6) days, P=0.031] and increased length of hospitalization [(23±12) vs. (16±8) days, P<0.01]. These trends were similar in patients with hypertension.Conclusions: For patients with excessive inflammatory responses and stable hemodynamics, ACEIs or ARBs might be tried to relieve the inflammatory storm, but the antiviral treatment should be enforced and the hemodynamics should be monitored closely; for patients with low levels of proinflammatory factors or instability hemodynamics, the agents might not be used to avoid a delay in viral clearance or increase the risk of shock.

scholarly journals Interactive Effectiveness of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers or Their Combination on Survival of Hemodialysis Patients

2017 ◽  
Vol 46 (6) ◽  
pp. 439-447 ◽  
Author(s):  
Ryo Kido ◽  
Tadao Akizawa ◽  
Masafumi Fukagawa ◽  
Yoshihiro  Onishi ◽  
Takuhiro Yamaguchi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Hemodialysis Patients ◽  
Converting Enzyme ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
All Cause Mortality ◽  
Receptor Blockers

Background: Does the use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers individually or as a combination confer a survival benefit in hemodialysis patients? The answer to this question is yet unclear. Methods: We performed a case-cohort study using data from the Mineral and Bone Disorder Outcomes Study for Japanese CKD stage 5D patients (MBD-5D), a 3-year multicenter prospective case-cohort study, including 8,229 hemodialysis patients registered from 86 facilities in Japan. All patients had secondary hyperparathyroidism, a condition defined as a parathyroid hormone level ≥180 pg/mL and/or receiving vitamin D receptor activators. We compared all-cause mortality rates between those receiving ACEI, ARB, and their combination and non-users with interaction testing. We used marginal structural Poisson regression (causal model) to estimate the causal effect and interaction adjusted for possible time-dependent confounding. Cardiovascular mortality was also evaluated. Results: Among 3,762 randomly sampled subcohort patients, those taking ACEI, ARB, and their combination at baseline accounted for 4.0, 31.6, and 3.8%, respectively. Over 3 years, 1,226 all-cause and 462 cardiovascular deaths occurred. Compared to non-users, ARB-alone users had a lower all-cause mortality rate (adjusted incident rate ratio [aIRR] 0.62, 95% CI 0.50–0.76), whereas ACEI-alone users showed a statistically similar rate (aIRR 1.01, 95% CI 0.57–1.77). On the contrary, combination users had a greater mortality rate (aIRR 2.56, 95% CI 1.22–5.37), showing significant interaction (p = 0.03). Analysis for cardiovascular mortality showed similar results. Conclusion: Among hemodialysis patients with secondary hyperparathyroidism, unlike ACEI use, ARB use was associated with greater survival than non-use. Conversely, combination use was associated with greater mortality. Controlled trials are warranted to verify the causality factors of these associations.

scholarly journals Angiotensin converting enzyme inhibitors and risk of lung cancer: population based cohort study

BMJ ◽  
2018 ◽  
pp. k4209 ◽  
Author(s):  
Blánaid M Hicks ◽  
Kristian B Filion ◽  
Hui Yin ◽  
Lama Sakr ◽  
Jacob A Udell ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cohort Study ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Population Based ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
Increased Risk ◽  
Receptor Blockers

AbstractObjectiveTo determine whether the use of angiotensin converting enzyme inhibitors (ACEIs), compared with use of angiotensin receptor blockers, is associated with an increased risk of lung cancer.DesignPopulation based cohort study.SettingUnited Kingdom Clinical Practice Research Datalink.ParticipantsA cohort of 992 061 patients newly treated with antihypertensive drugs between 1 January 1995 and 31 December 2015 was identified and followed until 31 December 2016.Main outcome measuresCox proportional hazards models were used to estimate adjusted hazard ratios with 95% confidence intervals of incident lung cancer associated with the time varying use of ACEIs, compared with use of angiotensin receptor blockers, overall, by cumulative duration of use, and by time since initiation.ResultsThe cohort was followed for a mean of 6.4 (SD 4.7) years, generating 7952 incident lung cancer events (crude incidence 1.3 (95% confidence interval 1.2 to 1.3) per 1000 person years). Overall, use of ACEIs was associated with an increased risk of lung cancer (incidence rate 1.6 v 1.2 per 1000 person years; hazard ratio 1.14, 95% confidence interval 1.01 to 1.29), compared with use of angiotensin receptor blockers. Hazard ratios gradually increased with longer durations of use, with an association evident after five years of use (hazard ratio 1.22, 1.06 to 1.40) and peaking after more than 10 years of use (1.31, 1.08 to 1.59). Similar findings were observed with time since initiation.ConclusionsIn this population based cohort study, the use of ACEIs was associated with an increased risk of lung cancer. The association was particularly elevated among people using ACEIs for more than five years. Additional studies, with long term follow-up, are needed to investigate the effects of these drugs on incidence of lung cancer.

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