Abstract P258: The Use Of Ace Inhibitors And Angiotensin Receptor Blockers Is Associated With Decreased Mortality And Increased Hospitalization Rate In Covid-19 Patients

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Aaron Douen ◽  
Jeremy Oh ◽  
Wesley Romney ◽  
Ryan Panetti ◽  
Prakash Ramdass ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Angiotensin Receptor Blockers ◽  
Hospitalization Rate ◽  
Host Cells ◽  
Channel Blockers ◽  
Multivariate Logistic Regression ◽  
Converting Enzyme Inhibitors ◽  
All Cause Mortality ◽  
Receptor Blockers ◽  
Secondary Outcomes

Introduction: Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are well known for upregulating ACE2 receptors. SARS-Cov-2 (COVID-19) infection utilizes the ACE2 receptor for proliferation and infection of host cells. Hypothesis: We hypothesize that the use of ACEI/ARBs will lead to a higher mortality and hospitalization rate among COVID-19 infected patients. Methods: The electronic health database at a public hospital in New York City was queried retrospectively for patients 18 years and older with a positive test for COVID-19 between 3/1/2020 - 4/1/2021. We examined baseline characteristics including comorbidities and whether they were prescribed ACEI/ARBs versus other medications including beta-blockers, calcium channel blockers, thiazides, or hydralazine. We categorized patients based on ACEI/ARB. The primary outcomes were all-cause mortality and hospitalization. The secondary outcomes were acute kidney injury, ventricular arrhythmia, myocardial infarction, heart failure, and intubation. We adjusted for comorbidities using multivariate logistic regression. Results: We identified 23,068 patients positive for SARS-CoV-2; 1,385 on ACEI/ARBs and 21,683 not on ACE/ARBs. The mean age in years was 65.90 +- 14.35 (SEM 0.386) and 44.01+-16.76, (SEM 0.114) for ACEI/ARB and non-ACEI/ARB respectively (p<0.001). The incidence of all cause mortality and hospitalization rate were significantly greater in the ACEI/ARB group. However, when adjusted for comorbidities using multivariate logistic regression, OR for mortality was 0.41 (CI 0.32-0.52, p<0.001) and for hospitalization was 4.12 (CI 3.49-4.86 p<0.001). For the secondary outcomes, non-ACEI/ARB patients had significantly increased unadjusted odds of all outcomes (p<0.001), except for ventricular tachycardia (p<0.618) and intubation (p< 0.214). Conclusion: Patients in the ACEI/ARB group demonstrated significantly lower mortality and increased hospitalization rates. Increased hospitalization may be due to more comorbidities. These results highlight the importance of continuing the use of ACEI and ARBs in COVID-19 patients for treatment of comorbidities and cardioprotective effects.

Abstract 14077: One-year Outcome After PCI in Patients Treated Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers - Subanalysis From Multicenter Registry -

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Inagaki YUSUKE ◽  
Kentaro Jujo ◽  
Hiroyuki Tanaka ◽  
Toshiaki Oka ◽  
KAZUHO KAMISHIMA ◽  
...  
Keyword(s):  
Angiotensin Converting Enzyme ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
All Cause Mortality ◽  
Receptor Blockers ◽  
One Year

Background: The prescription of inhibitors for renin-angiotensin-aldosterone system (RAAS) is associated with improved prognosis but have respectively different mechanisms of action in patients with coronary artery disease (CAD). We aimed to compare the clinical outcomes between angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) therapy in patients with CAD undergoing percutaneous coronary intervention (PCI). Methods: This study is a subanalysis from the TWINCRE registry that is a multicentral prospective cohort including patients who underwent PCI. After excluding 18 patients who received both ACEi and ARB from 2,896 registered patients, we ultimately evaluated 369 patients treated with ACEi, 492 with ARB and 541 without ACEi or ARB. The primary endpoint was a major adverse cardiovascular and cerebrovascular events (MACCE) including death from any cause, acute coronary syndrome, stent thrombosis, stroke and hospitalization for heart failure. The impact of RAAS inhibitors on all-cause mortality alone was also evaluated. Results: During the observation period with 366 days of a median follow-up, Kaplan-Meier analysis revealed that the ARB group had the lowest rate of MACCE than other two groups (Log-rank for trend, p&lt; for < 0.0001, Figure). Regarding all-cause mortality, the ARB group and ACEi group had comparable rates for MACCE, which were lower than the no-ACEi/ARB group (p&lt; for < 0.0001). In a Cox regression analysis, after adjusting with age, gender, comorbidities, multivessel disease, acute myocardial infarction, and medications at discharge including dual antiplatelet therapy and statins, ARB therapy was still had a superiority to ACEi therapy regarding with MACCE (hazard ratio: 0.54, 95% confidence interval: 0.30-0.98). Conclusion: In the multicenter cohort study, ARB therapy was associated with better one-year clinical outcomes compared to ACEi therapy in patients undergoing PCI.

Pharmacology of vasodilators

ESC CardioMed ◽  
2018 ◽  
pp. 180-184
Author(s):  
Stéphane Laurent
Keyword(s):  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Organic Nitrates ◽  
Channel Blockers ◽  
Resistance Arteries ◽  
Converting Enzyme Inhibitors ◽  
Receptor Blockers ◽  
Small Resistance ◽  
Direct Acting

Antihypertensive and antianginal agents are differentially able to vasodilate small resistance arteries, large conducting arteries, and epicardial coronary arteries. Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and alpha-adrenergic antagonists are not addressed here, since they are discussed in specific chapters. This chapter discusses the pharmacology of calcium channel blockers, nitrovasodilators, and direct-acting vasodilators. Dihydropyridines, such as nifedipine and amlodipine, are compared to the non-dihydropyridine agents verapamil and diltiazem. Organic nitrates, such as nitroglycerine and isosorbide dinitrate, are compared to inorganic nitrates, such as sodium nitroprusside. Molsidomine and nicorandil are also discussed. Finally, the pharmacology of direct-acting vasodilators focuses on minoxidil and hydralazine. Pharmacology of mechanisms of action is detailed to better understand therapeutic indications and side effects.

scholarly journals Role of antihypertensive drugs in the treatment of migraine

2015 ◽  
Vol 156 (5) ◽  
pp. 179-185 ◽  
Author(s):  
Gergely Fehér ◽  
Gabriella Pusch
Keyword(s):  
Enzyme Inhibitors ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Channel Blockers ◽  
Migraine Prevention ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
Receptor Blockers

The treatment of migraine depends on the frequency, severity and concomitant diseases. There are several specific drugs developed for migraine prevention in addition to the additive antimigraine effects of some other non-specific drugs. The aim of this literature-based review is to summarize the possible antimigraine properties of different antihypertensive agents (beta-blockers, calcium channel blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, etc.) focusing on the possible side effects (avoidance of beta blockers in the absence of heart disease, possible antiparkinson effect of calcium channel blockers, additive effect of drugs modifying the renin-angiotensin system activity, etc.). Current evidence supports the use of angiotensin converting enzyme inhibitors (mainly lisinopril) and angiotensin receptor blockers (mainly candesartan) for long-term migraine prevention and blood pressure control. Long-term beta-blocker treatment should be avoided in the absence of ischemic heart disease due to possible unfavourable cardiovascular effects. Orv. Hetil., 2015, 156(5), 179–185.

scholarly journals Effects of Different Anti-hypertensive Drugs on Hospitalized Patients With COVID-19 and Hypertension in China

2020 ◽  
Author(s):  
Xia Shi ◽  
Mengli Cao ◽  
Shourong Liu ◽  
Peifen Chen ◽  
Feng Hu ◽  
...  
Keyword(s):  
Enzyme Inhibitors ◽  
Clinical Laboratory ◽  
Angiotensin Receptor Blockers ◽  
Combined Therapy ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Drug Regimen ◽  
Channel Blockers ◽  
Converting Enzyme Inhibitors ◽  
Clinical Prognosis ◽  
Receptor Blockers

Abstract Background and aims: Calcium channel blockers (CCBs) and angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) are commonly used in the treatment of hypertension. However, it is still not clear whether there are differences among different anti-hypertensive drugs in the treatment of patients with coronavirus disease 2019 (COVID-19) and hypertension. Herein, we aimed to assess the relation between different anti-hypertensive medications and COVID-19 outcomes. Materials and methods: We conducted a retrospective analysis of 58 hypertensive patients with COVID-19 who were treated with different anti-hypertensive drugs and reviewed the clinical data obtained from electronic medical records, including epidemiological, clinical, laboratory, and the treatment and progression of the disease. Results: There was no obvious difference in clinical prognosis after using any anti-hypertensive drugs in patients with COVID-19 and hypertension, but the different anti-hypertensive drugs were associated with the use of non-invasive ventilator treatment at admission comparing two groups between ACEIs/ARBs and CCBs+ACEIs/ARBs. Conclusion: there is no evidence showing that the different use of anti-hypertensive drugs is related to outcomes of patients with COVID-19 and hypertension, even between single drug regimen and combined therapy (with at least two anti-hypertensive drugs as combined therapy).

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 Clinical Outcomes From COVID-19 Following Use of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers Among Patients with Hypertension in South Korea: A nationwide study

2020 ◽  
Author(s):  
Ju Hwan Kim ◽  
Yeon-Hee Baek ◽  
Hyesung Lee ◽  
Young June Choe ◽  
Hyun Joon Shin ◽  
...  
Keyword(s):  
South Korea ◽  
Clinical Outcomes ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
All Cause Mortality ◽  
Receptor Blockers

There is ongoing debate as to whether angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) use is associated with poor prognosis of coronavirus disease-2019 (COVID-19). We sought to investigate the association between ACEI/ARB use and risk of poor clinical outcomes from COVID-19. We identified 1,290 patients with hypertension, of which 682 had recorded ACEI/ARB use and 608 without the use during 30 days preceding the date of COVID-19 diagnosis in completely enumerated COVID-19 cohort in South Korea. Our primary endpoint was the clinical outcomes comprised of all-cause mortality, use of mechanical ventilation, intensive care unit (ICU) admission, and sepsis. We used inverse probability of treatment weighting (IPTW) to mitigate selection bias, and Poisson regression model to estimate the relative risks (RR) and 95% confidence intervals (CI) to compare outcomes in ACEI/ARB users with non-users. Compared to non-use, ACEI/ARB use was associated with lower clinical outcomes (IPTW adjusted RR, 0.60; 95% CI, 0.42-0.85; p=0.0046). When assessed by individual outcomes, ACEI/ARB use was not associated with all-cause mortality (IPTW adjusted RR, 0.62; 95% CI, 0.35-1.09; p=0.0973) and respiratory events (IPTW adjusted RR, 0.99; 95% CI, 0.84-1.17; p=0.9043). Subgroup analysis showed a trend toward protective role of ACEIs and ARBs against overall outcomes in men (IPTW adjusted RR, 0.84; 95% CI, 0.69-1.03; p-for-interaction=0.008) and with pre-existing respiratory disease (IPTW adjusted RR, 0.74; 95% CI, 0.60-0.92; p-for-interaction=0.0023). We present clinical evidence to support continuing ACE/ARB use in completely enumerated hypertensive COVID-19 cohort in South Korea.

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