scholarly journals SARS-CoV-2 infection and adverse outcomes in users of ACE inhibitors and angiotensin-receptor blockers: a nationwide case-control and cohort analysis

Thorax ◽  
2020 ◽  
pp. thoraxjnl-2020-215768 ◽  
Author(s):  
Christian Fynbo Christiansen ◽  
Anton Pottegård ◽  
Uffe Heide-Jørgensen ◽  
Jacob Bodilsen ◽  
Ole Schmeltz Søgaard ◽  
...  
Keyword(s):  
Angiotensin Receptor Blockers ◽  
Cohort Analysis ◽  
Case Control ◽  
Adverse Outcomes ◽  
Angiotensin Receptor ◽  
Current Recommendation ◽  
Icu Admission ◽  
Registration Number ◽  
Receptor Blockers ◽  
The Impact

ObjectiveTo examine the impact of ACE inhibitor (ACE-I)/angiotensin receptor blocker (ARB) use on rate of SARS-CoV-2 infection and adverse outcomes.MethodsThis nationwide case-control and cohort study included all individuals in Denmark tested for SARS-CoV-2 RNA with PCR from 27 February 2020 to 26 July 2020. We estimated confounder-adjusted ORs for a positive test among all SARS-CoV-2 tested, and inverse probability of treatment weighted 30-day risk and risk ratios (RRs) of hospitalisation, intensive care unit (ICU) admission and mortality comparing current ACE-I/ARB use with calcium channel blocker (CCB) use and with non-use.ResultsThe study included 13 501 SARS-CoV-2 PCR-positive and 1 088 695 PCR-negative individuals. Users of ACE-I/ARB had a marginally increased rate of a positive PCR when compared with CCB users (aOR 1.17, 95% CI 1.00 to 1.37), but not when compared with non-users (aOR 1.00 95% CI 0.92 to 1.09).Among PCR-positive individuals, 1466 (11%) were ACE-I/ARB users. The weighted risk of hospitalisation was 36.5% in ACE-I/ARB users and 43.3% in CCB users (RR 0.84, 95% CI 0.70 to 1.02). The risk of ICU admission was 6.3% in ACE-I/ARB users and 5.4% in CCB users (RR 1.17, 95% CI 0.64 to 2.16), while the 30-day mortality was 12.3% in ACE-I/ARB users and 13.9% in CCB users (RR 0.89, 95% CI 0.61 to 1.30). The associations were similar when ACE-I/ARB users were compared with non-users.ConclusionsACE-I/ARB use was associated neither with a consistently increased rate nor with adverse outcomes of SARS-CoV-2 infection. Our findings support the current recommendation of continuing use of ACE-Is/ARBs during the SARS-CoV-2 pandemic.Trial registration numberEUPAS34887

scholarly journals Angiotensin-Converting Enzyme (ACE) Inhibitors and Angiotensin Receptor Blockers (ARB) Are Protective Against ICU Admission and Mortality for Patients With COVID-19 Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Rawan ElAbd ◽  
Dana AlTarrah ◽  
Sarah AlYouha ◽  
Hamad Bastaki ◽  
Sulaiman Almazeedi ◽  
...  
Keyword(s):  
Angiotensin Converting Enzyme ◽  
Disease Severity ◽  
Angiotensin Receptor Blockers ◽  
Current Evidence ◽  
Secondary Outcome ◽  
Converting Enzyme ◽  
Angiotensin Receptor ◽  
Icu Admission ◽  
Receptor Blockers ◽  
The Impact

Introduction: Corona Virus disease 2019 (COVID-19) caused by the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) has become a global pandemic. The aim of this study was to investigate the impact of being on an Angiotensin-Converting Enzyme Inhibitors (ACEI) and/or Angiotensin Receptor Blockers (ARB) on hospital admission, on the following COVID-19 outcomes: disease severity, ICU admission, and mortality.Methods: The charts of all patients consecutively diagnosed with COVID-19 from the 24th of February to the 16th of June of the year 2020 in Jaber Al-Ahmed Al-Sabah hospital in Kuwait were checked. All related patient information and clinical data was retrieved from the hospitals electronic medical record system. The primary outcome was COVID-19 disease severity defined as the need for Intensive Care Unit (ICU) admission. Secondary outcome was mortality.Results: A total of 4,019 COVID-19 patients were included, of which 325 patients (8.1%) used ACEI/ARB, users of ACEI/ARB were found to be significantly older (54.4 vs. 40.5 years). ACEI/ARB users were found to have more co-morbidities; diabetes (45.8 vs. 14.8%) and hypertension (92.9 vs. 13.0%). ACEI/ARB use was found to be significantly associated with greater risk of ICU admission in the unadjusted analysis [OR, 1.51 (95% CI: 1.04–2.19), p = 0.028]. After adjustment for age, gender, nationality, coronary artery disease, diabetes and hypertension, ICU admission was found to be inversely associated with ACEI use [OR, 0.57 (95% CI: 0.34–0.88), p = 0.01] and inversely associated with mortality [OR, 0.56 (95% CI: 0.33–0.95), p = 0.032].Conclusion: The current evidence in the literature supports continuation of ACEI/ARB medications for patients with co-morbidities that acquire COVID-19 infection. Although, the protective effects of such medications on COVID-19 disease severity and mortality remain unclear, the findings of the present study support the use of ACEI/ARB medication.

scholarly journals Association of outpatient ACE inhibitors and angiotensin receptor blockers and outcomes of acute respiratory illness: a retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044010
Author(s):  
Molly Moore Jeffery ◽  
Nathan W Cummins ◽  
Timothy M Dempsey ◽  
Andrew H. Limper ◽  
Nilay D Shah ◽  
...  
Keyword(s):  
Ace Inhibitors ◽  
Retrospective Cohort ◽  
Angiotensin Receptor Blockers ◽  
Cohort Analysis ◽  
Respiratory Illness ◽  
Angiotensin Receptor ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
The Usa ◽  
Receptor Blockers

ObjectivesEvaluate associations between ACE inhibitors (ACEis) and angiotensin receptor blockers (ARBs) and clinical outcomes in acute viral respiratory illness (AVRI).DesignRetrospective cohort analysis of claims data.SettingThe USA; 2018–2019 influenza season.ParticipantsMain cohort: people with hypertension (HTN) taking an ACEi, ARB or other HTN medications, and experiencing AVRI. Falsification cohort: parallel cohort receiving elective knee or hip replacement.Main outcome measuresMain cohort: hospital admission, intensive care unit, acute respiratory distress (ARD), ARD syndrome and all-cause mortality. Falsification cohort: complications after surgery and all-cause mortality.ResultsThe main cohort included 236 843 episodes of AVRI contributed by 202 629 unique individuals. Most episodes were in women (58.9%), 81.4% in people with Medicare Advantage and 40.3% in people aged 75+ years. Odds of mortality were lower in the ACEi (0.78 (0.74 to 0.83)) and ARB (0.64 (0.61 to 0.68)) cohorts compared with other HTN medications. On all other outcomes, people taking ARBs (but not ACEis) had a >10% reduction in odds of inpatient stays compared with other HTN medications.In the falsification analysis (N=103 353), both ACEis (0.89 (0.80 to 0.98)) and ARBs (0.82 (0.74 to 0.91)) were associated with decreased odds of complications compared with other HTN medications; ARBs (0.64 (0.47 to 0.87)) but not ACEis (0.79 (0.60 to 1.05)) were associated with lower odds of death compared with other HTN medications.ConclusionsOutpatient use of ARBs was associated with better outcomes with AVRI compared with other medications for HTN. ACEis were associated with reduced risk of death, but with minimal or no reduction in risk of other complications. A falsification analysis conducted to provide context on the possible causal implications of these findings did not provide a clear answer. Further analysis using observational data will benefit from additional approaches to assess causal relationships between these drugs and outcomes in AVRI.

Abstract 15514: Ace Inhibitors, Angiotensin Receptor Blockers, and Outcomes in Hospitalized Patients With Severe Covid-19 Pneumonia

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Prabhjot Grewal ◽  
Jeanwoo Yoo ◽  
Aikaterini Papamanoli ◽  
Azad Mojahedi ◽  
Simrat Dhaliwal ◽  
...  
Keyword(s):  
Ace Inhibitors ◽  
Cox Regression ◽  
Angiotensin Receptor Blockers ◽  
Patient Characteristics ◽  
University Hospital ◽  
Target Cells ◽  
Angiotensin Receptor ◽  
Receptor Blockers ◽  
Artery Disease ◽  
The Impact

Introduction: Angiotensin converting enzyme (ACE) 2, is a co-receptor for the entry of SARS-CoV-2 into target cells. The impact of ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) on outcomes in patients with coronavirus disease 19 (COVID-19) is under investigation. Hypothesis: ACEIs/ARBs are associated with worse outcomes in patients hospitalized with COVID-19. Methods: We evaluated the in-hospital course of 469 adults admitted to Stony Brook University Hospital, NY, from March 1 to April 15, 2020 with severe COVID-19 pneumonia (need for high-flow O2). We excluded patients who required mechanical ventilation (MV) or died within 24h of admission. We used Cox regression models to examine the association of previous (home) use of ACEIs or ARBs with mortality and the composite of death or MV. Results: Table 1 summarizes the patient characteristics according to ACEI/ARB use (ACEI: 73; ARB: 73; 146/469 patients, 31.1%). After a median of 13 days (8-22), 123 patients (26.2%) died and 105 patients (22.4%) required MV and survived. In models adjusting for age, sex, race, body mass index, hypertension, diabetes, coronary artery disease, heart failure, atrial fibrillation, chronic lung disease, chronic kidney disease, and baseline 0 2 saturation, ACEIs/ARBs were not associated with mortality (HR 1.00; 95%CI 0.62-1.61; P=0.99). There was no difference between classes in mortality (ACEI vs. ARB: HR 1.14; 95%CI 0.61-2.15; P=0.68). However, there was a trend towards lower rates of death or MV with ACEI/ARB (HR 0.75; 95%CI 0.54-1.05; P=0.095), mainly because of lower MV rates. The protective effect of ARBs on the composite was significant (HR 0.66; 95%CI 0.44-0.99; P=0.046) whereas that of ACEIs was not (HR 0.87; 95%CI 0.57-1.31; P=0.50), albeit difference was not significant (P=0.28). Conclusions: In patients with severe COVID-19 pneumonia, ACEI/ARB use was not associated with mortality. Especially ARBs may reduce need for MV in this high-risk COVID-19 population.

scholarly journals The impact of angiotensin receptor blockers on arterial stiffness: a meta-analysis

2015 ◽  
Vol 38 (9) ◽  
pp. 613-620 ◽  
Author(s):  
Feng Peng ◽  
Hongming Pan ◽  
Bin Wang ◽  
Jinxiu Lin ◽  
Wenquan Niu
Keyword(s):  
Arterial Stiffness ◽  
Angiotensin Receptor Blockers ◽  
Meta Analysis ◽  
Angiotensin Receptor ◽  
Receptor Blockers ◽  
The Impact

Abstract 17433: Improved Outcomes in Septic Shock With Pre-hospitalization Use of Angiotensin-converting Enzyme Inhibitors (ACEI) and Angiotensin Receptor Blockers (ARB)

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Sagger Mawri ◽  
Jainil Shah ◽  
Jain Tarun ◽  
Rami Dirani ◽  
Alexander Michaels ◽  
...  
Keyword(s):  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Left Ventricular ◽  
Converting Enzyme ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
Icu Admission ◽  
Improved Outcomes ◽  
Receptor Blockers

Background: The neurohormonal effects of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are well recognized. Recent molecular studies have also demonstrated novel immune-modulating properties of ACEI/ARB through reduction of pro-inflammatory cytokines. In a recent study, obese trauma patients on pre-injury ACEI/ARB had reduced multi-organ failure scores and improved T cell function and monocyte maturation as compared to those not on ACEI/ARB. We sought to determine whether pre-hospital use of ACEI/ARB conferred improvements in outcomes in patients with septic shock (SS). Methods: We evaluated 248 patients admitted to the ICU with SS from January 2011 to April 2013. Comprehensive baseline demographic, clinical and echocardiographic data was obtained at time of ICU admission. We identified 90 patients on ACEI/ARB prior to ICU admission. Chi-square and t-tests were used to assess for differences in clinical parameters and outcomes in patients who were on ACE/ARB prior to ICU admission (ACE/ARB group) versus those not on ACEI/ARB prior to ICU admission (non-ACEI/ARB group). Results: Patients in the ACE/ARB group (36%) had significantly lower heart rate (95.8 bpm vs 102.3 bpm, p<0.05), higher MAP (80 mmHg vs 74 mmHg, p<0.05), higher serum potassium level (4.3 mEq/L vs 4.0 mEq/L, p<0.05), and less urine output (522cc vs 708cc per initial 24 hours, p<0.05) with a non-significant trend towards lower respiratory rate, WBC count, lactate level and APACHE 2 score. The ACEI/ARB group had higher left ventricular systolic diameter (1.26 cm vs 1.17 cm, p<0.05) and left ventricular posterior wall diameter (1.18 cm vs 1.07 cm, p<0.05); however, there were no other statistically significant echocardiographic differences between both groups. In-hospital and 90-day mortality was significantly less in the ACE/ARB group compared to the non-ACE/ARB group (20% vs 31.7%, p <0.05) and (25.6% vs 38%, p <0.05), respectively. Conclusion: ACEI/ARB use prior to ICU admission is associated with improved outcomes in SS patients, not explained by laboratory or echocardiographic differences. This provides further support for the possible immunomodulating benefits of ACEI/ARBs; however, more studies are needed to confirm these findings.

scholarly journals Use of angiotensin receptor blockers and risk of dementia in a predominantly male population: prospective cohort analysis

BMJ ◽  
2010 ◽  
Vol 340 (jan12 1) ◽  
pp. b5465-b5465 ◽  
Author(s):  
N.-C. Li ◽  
A. Lee ◽  
R. A Whitmer ◽  
M. Kivipelto ◽  
E. Lawler ◽  
...  
Keyword(s):  
Prospective Cohort ◽  
Angiotensin Receptor Blockers ◽  
Cohort Analysis ◽  
Angiotensin Receptor ◽  
Male Population ◽  
Receptor Blockers

Angiotensin II inhibition: a potential treatment to slow the progression of sarcopenia

2021 ◽  
Vol 135 (21) ◽  
pp. 2503-2520
Author(s):  
Jeffrey Kingsley ◽  
Keiichi Torimoto ◽  
Tomoki Hashimoto ◽  
Satoru Eguchi
Keyword(s):  
Physical Disability ◽  
Angiotensin Receptor Blockers ◽  
Hospital Readmissions ◽  
Adverse Outcomes ◽  
Nutritional Deficiencies ◽  
Metabolic Efficiency ◽  
Angiotensin Receptor ◽  
Receptor Blockers ◽  
Endocrine Factors ◽  
Overall Mortality

Abstract Sarcopenia is defined as the progressive and generalized loss of skeletal muscle mass and strength, which is associated with increased likelihood of adverse outcomes including falls, fractures, physical disability, and mortality. The etiology of sarcopenia has been postulated to be multifactorial with genetics, aging, immobility, nutritional deficiencies, inflammation, stress, and endocrine factors all contributing to the imbalance of muscle anabolism and catabolism. The prevalence of sarcopenia is estimated to range from 13 to 24% in adults over 60 years of age and up to 50% in persons aged 80 and older. As the population continues to age, the prevalence of sarcopenia continues to increase and is expected to affect 500 million people by the year 2050. Sarcopenia impacts the overall health of patients through limitations in functional status, increase in hospital readmissions, poorer hospital outcomes, and increase in overall mortality. Thus, there exists a need to prevent or reduce the occurrence of sarcopenia. Here, we explore the potential mechanisms and current studies regarding angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors on reducing the development of sarcopenia through the associated changes in cardiovascular function, renal function, muscle fiber composition, inflammation, endothelial dysfunction, metabolic efficiency, and mitochondrial function.

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