Inhibitors of the renin–angiotensin–aldosterone system and COVID-19 in critically ill elderly patients

Abstract BackgroundThe influence of renin-angiotensin-aldosterone system (RAAS) inhibitors on the critically ill COVID-19 patients with pre-existing hypertension remains uncertain. This study examined the impact of previous use of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) on the critically ill COVID-19 patients.MethodsData from an international, prospective, observational cohort study involving 354 hospitals spanning 54 countries were included. A cohort of 746 COVID-19 patients with pre-existing hypertension admitted to intensive care units (ICUs) in 2020 were targeted. Multi-state survival analysis was performed to evaluate in-hospital mortality and hospital length of stay up to 90 days following ICU admission.ResultsA total of 746 patients were included - 543 (73%) with pre-existing hypertension had received ACEi/ARBs before ICU admission, while 203 (27%) had not. Cox proportional hazards model showed that previous ACEi/ARB use was associated with a decreased hazard of in-hospital death (HR, 0.73, 95% CI, 0.58 to 0.93). Sensitivity analysis adjusted for propensity scores showed similar results for hazards of death. The average length of hospital stay was longer in ACEi/ARB group with 21.4 days (95% CI: 19.9 to 23.0 days) in ICU and 6.7 days (5.9 to 7.6 days) in general ward compared to non-ACEi/ARB group with 16.2 days (14.1 to 18.5 days) and 6.3 days (5.0 to 7.7 days), respectively. When analysed separately, there was insufficient evidence of differential effects between ACEi and ARB use on the hazards of death and discharge.ConclusionsIn critically ill COVID-19 patients with comorbid hypertension, use of ACEi/ARBs prior to ICU admission was associated with a reduced risk of in-hospital mortality following adjustment for baseline characteristics although patients with ACEi/ARB showed longer length of hospital stay.

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EFFECTS OF PROGESTERONE AND OF FOUR SYNTHETIC GESTAGENS ON THE RENIN-ANGIOTENSIN-ALDOSTERONE-SYSTEM IN MAN.

Acta Endocrinologica ◽

10.1530/acta.0.077s055 ◽

1974 ◽

Vol 77 (1_Suppl) ◽

pp. S55

Author(s):

W. Oelkers ◽

M. Schöneshöfer ◽

H. Blümel ◽

H. Kutschke ◽

H. Kreiser ◽

...

Keyword(s):

Renin Angiotensin Aldosterone System ◽

Renin Angiotensin

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NATRIURETIC PEPTIDES LEVEL AND THE STATUS OF THE RENIN – ANGIOTENSIN-ALDOSTERONE SYSTEM IN CHRONIC KIDNEY DISEASE IN PATIENTS WITH CONGENITAL MALFORMATIONS OF THE URINARY SYSTEM

Nephrology (Saint-Petersburg) ◽

10.24884/1561-6274-2018-22-5-45-50 ◽

2018 ◽

Vol 22 (5) ◽

pp. 45-50

Author(s):

A. M. Mambetova ◽

A. M. Inarokova ◽

N. N. Shabalova ◽

D. V. Bizheva ◽

A. T. Mahiyeva

Keyword(s):

Congenital Malformations ◽

Control Group ◽

Healthy Children ◽

Urinary System ◽

Renin Angiotensin Aldosterone System ◽

Natriuretic Hormone ◽

Renin Angiotensin ◽

Group I ◽

The Status ◽

Sick Children

THE AIM. To determine the concentration of natriuretic peptide in the blood serum in children with congenital malformations of the urinary system (CM US) and to compare with the activity of renin-angiotensin-aldosterone system (RAAS).MATERIALS AND METHODS.119 patients with CM US aged 3 to 18 years were examined. A control group of 10 clinically healthy children. 3 groups were assigned: group I – 55 children with congenital vesicoureteral reflux, and group II – 34 children with congenital hydronephrosis and ureterohydronephrosis, III group – 30 children with other forms of dysembryogenesis of the US. Following indicators were identified by ELISA in the blood: renin, aldosterone, N – terminal propeptide natriuretic hormone (NT-рroВNР). RESULTS.NT-рroВNР, renin and aldosterone hyperproduction were diagnosed in 59,6%, 69,7%, 54.6 % of sick children relatively. Concentrations were higher in all variants of malformations in comparison with the control group. Significant differences were revealed in obstructive species, where arterial hypertension (AH) was diagnosed more often. Patients with AH recorded significantly higher concentrations of NT-proВNР and renin.CONCLUSION.The key point in pathological processes developmentand progression in the cardiovascular system and kidneys is the activation of RAAS. The system of natriuretic factors is important in maintaining the compensated state of patients due to the blockade of RAAS.

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