How ineffective hypertension control in subjects treated with angiotensin-converting enzyme inhibitors is related to polymorphisms in the renin-angiotensin-aldosterone system

COVID-19 is a new disease caused by the Sars-CoV-2 virus and the vast majority of patients have symptoms similar to a flu-like syndrome. A small portion of those infected ends up being hospitalized and may develop with the most severe presentation of the disease. Data from Chinese series report that hypertension appears to be a condition that imposes a greater risk of unfavorable evolution of patients. Some studies have reported that Sars-CoV-2 uses the angiotensin-converting enzyme to access its target cells. There are theories that differ about the protective or harmful role that drugs that act in the renin angiotensin aldosterone system in these patients. A British study suggests that patients using angiotensin-converting enzyme inhibitors had a lower incidence of severe forms of the disease. Another study carried out a retrospective and multicenter analysis showing that mortality was lower in the group that had used the drugs when compared to the other group (3,7 vs. 9,8%; p=0,01). The various hypotheses raised through pathophysiology are not yet able to really predict the best course of action for patients using drugs that act on the renin angiotensin system. Thus, a randomized study becomes important to try to answer definitively and with a high degree of reliability to this question.

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Cough Induced by Pharmacological ModulatiOn of the Renin-Angiotensin-Aldosterone System. Angiotensin Converting Enzyme Inhibitors And Angiotensin II Receptor Antagonists

Progress in Experimental Cardiology - Angiotensin II Receptor Blockade Physiological and Clinical Implications ◽

10.1007/978-1-4615-5743-2_10 ◽

1998 ◽

pp. 115-126

Author(s):

Yves Lacourcière ◽

Jean Lefebvre

Keyword(s):

Angiotensin Ii ◽

Angiotensin Converting Enzyme ◽

Enzyme Inhibitors ◽

Angiotensin Converting Enzyme Inhibitors ◽

Converting Enzyme ◽

Angiotensin Ii Receptor ◽

Angiotensin Ii Receptor Antagonists ◽

Converting Enzyme Inhibitors ◽

Renin Angiotensin Aldosterone System ◽

Pharmacological Modulation

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Impact of Renin-Angiotensin Aldosterone System Inhibition on Serum Potassium Levels among Peritoneal Dialysis Patients

American Journal of Nephrology ◽

10.1159/000479011 ◽

2017 ◽

Vol 46 (2) ◽

pp. 150-155 ◽

Cited By ~ 6

Author(s):

Silvia Carreira Ribeiro ◽

Ana Elizabeth Figueiredo ◽

Pasqual Barretti ◽

Roberto Pecoits-Filho ◽

Thyago Proença de Moraes ◽

...

Keyword(s):

Renal Function ◽

Peritoneal Dialysis ◽

Angiotensin Converting Enzyme ◽

Enzyme Inhibitors ◽

Serum Levels ◽

Angiotensin Converting Enzyme Inhibitors ◽

Converting Enzyme ◽

Dialysis Patients ◽

Converting Enzyme Inhibitors ◽

Renin Angiotensin

Background: The chronic use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blocker has been associated with hyperkalemia in patients with reduced renal function even after the initiation of hemodialysis. Whether such medications may cause a similar effect in peritoneal dialysis patients is not well established. So, the aim of our study was to analyze the impact of renin-angiotensin-aldosterone inhibitors on the serum levels of potassium in a national cohort of peritoneal dialysis patients. Method: A prospective, observational, nationwide cohort study was conducted. We identified all incident patients on peritoneal dialysis that had angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) prescribed for at least 3 months and a similar period of time without these medications. Patients were divided into 4 groups: Groups I and III correspond to patients using, respectively, an ACEi or ARB and then got the drug suspended; Groups II and IV started peritoneal dialysis without the use of any renin-angiotensin aldosterone system inhibitor and then got, respectively, an ACEi or ARB introduced. Changes in potassium serum levels were compared using 2 statistical approaches: (1) the non-parametric Wilcoxon test for repeated measures and (2) a crossover analysis. Results: Mean potassium serum levels at the first phase of the study for Groups I, II, III, and IV were, respectively, 4.46 ± 0.79, 4.33 ± 0.78, 4.41 ± 0.63, and 4.44 ± 0.56. Changes in mean potassium serum levels for Groups I, II, III, and IV were -0.10 ± 0.60, 0.02 ± 0.56, -0.06 ± 0.46, and 0.03 ± 0.50, respectively. Conclusion: The use of ACEi and ARB was not associated with a greater risk for hyperkalemia in stable peritoneal dialysis patients independently of residual renal function.

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