Clinical features of hypertensive patients with COVID-19 compared with a normotensive group: Single-center experience in China

Abstract Background SARS-CoV-2 has spread worldwide and poses a great threat to human health. Among COVID-19 patients, those with hypertension have been reported to have higher morbidity and mortality. This study was conducted to provide the international community with a deeper understanding of COVID-19 with hypertension. Methods A total of 623 COVID-19 patients enrolled in Wuhan’s hospital were studied from January to March 2020. The epidemiology, clinical features, and laboratory data of hypertensive patients with COVID-19 were collected, retrospectively analyzed, and compared with a normotensive group. The use of antihypertensive drugs, general treatment, and clinical outcomes of hypertensive patients were also analyzed. Results The median ages in hypertensive patients with mild and severe COVID-19 were both significantly greater than the median age in the normotensive group. But there was no significant gender difference between the hypertensive and normotensive groups. All patients had lived in Wuhan area. Common symptoms of all patients included fever, cough, and fatigue. Chest computed tomography (CT) scans showed bilateral patchy shadows or ground glass opacity in the lungs of all patients. All (315 (100%)) of the hypertensive patients received antiviral therapy (Umifenovir was used alone or in combination with Ribavirin), antibiotic therapy (215 (68.3%)), and corticosteroids (118 (37.5%)). The results suggest that the combination of Umifenovir and Ribavirin as initial therapy for hypertensive patients with COVID-19 is effective and safe. There were no significant differences in laboratory data between the mild cases in the hypertensive and the normotensive groups. In the severe cases, the hypertensive patients had higher plasma levels of D-dimer, C-reactive protein (CRP), and Interleukin-6 (IL-6) (P < 0.05). Furthermore, the hypertensive patients who were treated with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) were not represented in a statistically significant manner between the mild and severe groups (p > 0.05). Conclusion In this study, we demonstrated that the hypertensive patients who were treated with ACEI/ARB did not have an increased risk of developing severe COVID-19. Umifenovir and Ribavirin played an important role in the treatment of viral pneumonia. Hypertensive patients with severe viral pneumonia had stronger inflammatory responses than nonhypertensive patients.

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Clinical Features of Hypertensive Patients With Covid-19 Compared With a Normotensive Group

10.21203/rs.3.rs-31685/v1 ◽

2020 ◽

Author(s):

shuang wang ◽

qiang zhang ◽

zhao bin zheng ◽

peng wang ◽

hua hong ye ◽

...

Keyword(s):

Clinical Features ◽

Inflammatory Responses ◽

Angiotensin Receptor Blockers ◽

Laboratory Data ◽

Ground Glass Opacity ◽

Angiotensin Converting Enzyme Inhibitors ◽

Viral Pneumonia ◽

Converting Enzyme Inhibitors ◽

Hypertensive Patients ◽

Increased Risk

Abstract Background: The novel coronavirus (COVID-19), which began in Wuhan, China, in December 2019, has spread worldwide and poses a great threat to human health. Among COVID-19 patients, those with hypertension have been reported to have higher morbidity and mortality. This study was conducted to provide the international community with a deeper understanding of COVID-19 with hypertension.Methods: A total of 188 COVID-19 patients were studied from January to March 2020. The epidemiology, clinical features, and laboratory data of hypertensive patients with COVID-19 were collected, retrospectively analyzed, and compared with a normotensive group. The use of anti-hypertensive drugs, general treatment, and clinical outcomes of hypertensive patients were also analyzed.Results: The median ages in hypertensive patients with mild and severe COVID-19 were both significantly greater than the median age in the normotensive group. But there was no significant gender difference between the hypertensive and normotensive groups. All patients had lived in the Wuhan area. Common symptoms of all of the patients included fever, cough, and fatigue. Chest CT scans showed bilateral patchy shadows or ground glass opacity in the lungs of all of the patients. All (98 [100%]) of the hypertensive patients received antiviral therapy (Arbidol was used alone or in combination with Ribavirin), antibiotic therapy (85 [86.7%]), and corticosteroids (31 [31.6%]). It has been suggested that the combination of Arbidol and Ribavirin as initial therapy for hypertensive patients with COVID-19 is effective and safe. There were no significant differences in laboratory data between the mild cases in the hypertensive and the normotensive groups. In the severe cases, the hypertensive patients had higher plasma levels of D-dimer, C-reactive protein (CRP), and Interleukin-6 (IL-6) (P < 0.05). Furthermore, the hypertensive patients who were treated with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) had no statistically significant differences between the mild and severe groups (p > 0.05).Conclusion: In this study, we demonstrated that the hypertensive patients who were treated with ACEI/ARB did not have an increased risk of developing severe COVID-19. Arbidol and Ribavirin played an important role in the treatment of the viral pneumonia. Hypertensive patients with severe viral pneumonia had stronger inflammatory responses than non-hypertensive patients.

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Antihypertensive Drugs and the Risk of Cancer: A Nationwide Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10040771 ◽

2021 ◽

Vol 10 (4) ◽

pp. 771

Author(s):

In-Jeong Cho ◽

Jeong-Hun Shin ◽

Mi-Hyang Jung ◽

Chae Young Kang ◽

Jinseub Hwang ◽

...

Keyword(s):

Antihypertensive Drugs ◽

Beta Blockers ◽

Angiotensin Receptor Blockers ◽

Angiotensin Converting Enzyme Inhibitors ◽

Channel Blockers ◽

Antihypertensive Medications ◽

Converting Enzyme Inhibitors ◽

Incident Cancer ◽

Increased Risk ◽

Risk Of Cancer

We sought to assess the association between common antihypertensive drugs and the risk of incident cancer in treated hypertensive patients. Using the Korean National Health Insurance Service database, the risk of cancer incidence was analyzed in patients with hypertension who were initially free of cancer and used the following antihypertensive drug classes: Angiotensin-converting enzyme inhibitors (ACEIs); angiotensin receptor blockers (ARBs); beta blockers (BBs); calcium channel blockers (CCBs); and diuretics. During a median follow-up of 8.6 years, there were 4513 (6.4%) overall cancer incidences from an initial 70,549 individuals taking antihypertensive drugs. ARB use was associated with a decreased risk for overall cancer in a crude model (hazard ratio (HR): 0.744, 95% confidence interval (CI): 0.696–0.794) and a fully adjusted model (HR: 0.833, 95% CI: 0.775–0.896) compared with individuals not taking ARBs. Other antihypertensive drugs, including ACEIs, CCBs, BBs, and diuretics, did not show significant associations with incident cancer overall. The long-term use of ARBs was significantly associated with a reduced risk of incident cancer over time. The users of common antihypertensive medications were not associated with an increased risk of cancer overall compared to users of other classes of antihypertensive drugs. ARB use was independently associated with a decreased risk of cancer overall compared to other antihypertensive drugs.

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Anesthetic management of hypertensive patients

Journal of Korean Medical Association ◽

10.5124/jkma.2020.63.9.519 ◽

2020 ◽

Vol 63 (9) ◽

pp. 519-525

Author(s):

Duk Kyung Kim

Keyword(s):

Angiotensin Receptor Blockers ◽

Anesthetic Management ◽

Target Organ Damage ◽

Perioperative Period ◽

Organ Damage ◽

Target Organ ◽

Clear Understanding ◽

Converting Enzyme Inhibitors ◽

Hypertensive Patients ◽

Increased Risk

It is important for the clinicians to have a clear understanding of the anesthetic implications and increased risks due to hypertension to ensure safe surgical procedures in hypertensive patients. Preoperative hypertension is associated with greater intraoperative hemodynamic lability and an increased risk of perioperative cardiovascular complications. In addition to the patients’ baseline blood pressure (BP), the presence and severity of target organ damage and cardiovascular comorbidities should be evaluated preoperatively. Delaying surgery in hypertensive patients may be justified if there is an evidence of target organ damage that can be improved by such a delay. Further evaluation of suspected target organ damage before the surgery is also justified. Except withholding angiotensin-converting enzyme inhibitors/angiotensin receptor blockers 10 to 24 hours before the surgery, the continuation of preoperative antihypertensive therapy is generally recommended. Though maintaining perioperative BP within the range of 80%–90% to 110%–120% of the baseline BP (permissible BP decrease/increase ≤10%–20%) is generally recommended, an individualized and pathophysiology-based approach to control BP might be the best option throughout the perioperative period. In other words, BP targets in the perioperative period should be determined based on the type of surgery, patients’ baseline BP, risks of hypotension-related organ ischemia, and hypertension-related bleeding.

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Role of Drugs Affecting the Renin-Angiotensin-Aldosterone System on Susceptibility and Severity of COVID-19: A Large Case-Control Study from Zheijang Province, China

10.1101/2020.04.24.20077875 ◽

2020 ◽

Cited By ~ 6

Author(s):

Huadong Yan ◽

Ana M Valdes ◽

Amrita Vijay ◽

Shanbo Wang ◽

Lili Liang ◽

...

Keyword(s):

Disease Risk ◽

Antihypertensive Drugs ◽

Angiotensin Receptor Blockers ◽

Health Science ◽

Research Centre ◽

Converting Enzyme Inhibitors ◽

Increased Risk ◽

Critical Form ◽

Zhejiang Provincial

AbstractBackgroundMedical editorials have suggested that angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) should not be given to people with arterial hypertension during the coronavirus disease 2019 (COVID-19) pandemic because of a potential increased risk of worse clinical outcomes and that calcium channel blockers (CCBs) should be used as an alternative.MethodsUsing a cohort of 610 COVID-19 cases and 48,667 population-based controls from Zheijang, China we have tested the role of usage of ACEIs, ARBs, CCBs and other medications on risk and severity of COVID 19. Analyses were adjusted for age, sex and BMI and for presence of relevant comorbidities.FindingsHigher BMI, diabetes and cardio/ cerebrovascular disease are independent risk factors for the development of COVID-19. Individuals with hypertension taking CCBs had significantly increased risk [odds ratio (OR)= 1.67 (95% CI 1.2-2.9)) of manifesting symptoms of COVID-19 whereas those taking ARBs and diuretics had significantly lower disease risk (OR=0.24; 95%CI 0.17-0.34 and OR=0.32; 95%CI 0.19-0.57 respectively). Other antihypertensive drugs were not associated with increased risk of severe or critical form of the infection. Use of glucocorticoids was significantly associated with a severe/critical form of COVID-19 (OR= 7.56; 95%CI 1.17-48.93).InterpretationWe found no evidence to alter ARBs or ACEIs therapy in the context of the pandemic. Patients on corticosteroids with COVID-19 are at higher risk of developing a severe form of COVID-19and therefore should be monitored closely.FundingBy the Social Development Major Projects of Ningbo City (2016C51005), Medical Health Science and Technology Project of Zhejiang Provincial Health Commission (2018ZD039), Zhejiang Provincial natural science foundation (LGF20H030006) and by the NIHR Nottingham Biomedical Research Centre (Reference no: BRC-1215-20003).

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Clinical Outcome of Renin-Angiotensin-Aldosterone System Blockers in Treatment of Hypertensive Patients with COVID-19: A Systematic Review and Meta-Analysis

10.21203/rs.3.rs-69847/v1 ◽

2020 ◽

Author(s):

Andrea Laurentius ◽

Brian Mendel ◽

Radityo Prakoso

Keyword(s):

Clinical Outcome ◽

Antihypertensive Drugs ◽

Angiotensin Receptor Blockers ◽

Meta Analysis ◽

Heart Association ◽

Hospital Treatment ◽

Converting Enzyme Inhibitors ◽

Renin Angiotensin Aldosterone System ◽

Hypertensive Patients ◽

Renin Angiotensin

Abstract Background: Novel coronavirus disease 2019 has been stated as global disease pandemic due to its rapid spread worldwide. Up to 30% of Coronavirus Disease 2019 patients with hypertension are more susceptible to death. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers has been used as primary line of medication for hypertension; nonetheless, conflicting data arises as numerous studies showed contradictory results. Methods: Aiming to show clinical outcome of renin-angiotensin-aldosterone system blockers in hospital treatment of hypertensive patients with Coronavirus Disease 2019, systematically searched literatures through eight databases were intensively appraised using Strengthening the Reporting of Observational Studies in Epidemiology checklists for cohort studies. Results: Six encompassed studies in this meta-review showed in-hospital hypertensive Coronavirus Disease 2019 patients receiving antihypertensive drugs were associated to overall risk reduction of all-cause mortalities (hazard ratio = 0.54, confidence interval 95% = 0.33 – 0.86). Conclusion: Therefore, the results support recommendation by American Heart Association not to discontinue antihypertension regimens in Coronavirus Disease 2019 patients with hypertension. Further researches are required as that majority of the studies are originated from Asian countries along with comprehensive standardization of baseline characteristics.

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Abstract 438: Association between Insomnia and Use of BP-lowering Drugs in hypertensive Patients: a Cross-sectional Cohort Study

Hypertension ◽

10.1161/hyp.64.suppl_1.438 ◽

2014 ◽

Vol 64 (suppl_1) ◽

Author(s):

Rosa Maria Bruno ◽

Laura Palagini ◽

Veronica Mancuso ◽

Martina Cargiolli ◽

Angelo Gemignani ◽

...

Keyword(s):

Depressive Symptoms ◽

Trait Anxiety ◽

Antihypertensive Drugs ◽

Angiotensin Receptor Blockers ◽

Multiple Logistic Regression Analysis ◽

Female Gender ◽

Short Sleep Duration ◽

Cross Sectional ◽

Hypertensive Patients ◽

Drug Classes

Purpose: Insomnia and short sleep duration have been associated with increased prevalence, incidence and severity of hypertension. However, the relationship between insomnia and use of different antihypertensive drug classes has not been ascertained yet. Methods: 371 hypertensive patients at their first visit in a tertiary Hypertension Outpatient Unit were enrolled. Insomnia Severity Index (ISI), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAY-Y2) were administered. Insomnia was defined as ISI>8, depressive symptoms as BDI>10, trait anxiety as STAI -Y2>40. Patients with self-reported sleep apneas or snoring (n=29) or with incomplete data (n=12) were excluded. Results: Data from 330 patients were analyzed (males 51%, mean age 57±13 years, antihypertensive treatment 84%, previous CV events 9%, diabetes 7%, obesity 24%, smoking 13%, hypercholesterolemia 67%). Insomniacs (n=70, 21%) were older than non-insomniacs (60±11 vs 56±13 years, p=0.02); female gender (62 vs 46%, p=0.01), anxiety (68 vs 34%, p<0.0001) and depressive symptoms (30 vs 6%, p<0.0001) were more prevalent in insomniacs. Insomniacs were treated with higher number of antihypertensive drugs (1.8±1.0 vs 1.5±1.0, p=0.04) and more frequently with angiotensin-receptor-blockers (ARBs, 49 vs 31%, p=0.009) and diuretics (50 vs 28%, p=0.0007), whereas the use of other drug classes was similar. In a multiple logistic regression analysis, adjusted for cardiovascular and psychiatric variables, ARBs use (OR 2.4, CL95% 1.1-5.2), depressive symptoms (OR 3.2, CL95%1.2-8.7) and anxiety (OR 2.9, CL95%1.4-6.1) were associated with a higher probability of insomnia. Conclusions: This cross-sectional analysis suggests that ARBs use may be associated with insomnia in a cohort of hypertensive patients

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Antihypertensive Drugs and Diabetic Retinopathy in Patients with Type 2 Diabetes

Ophthalmologica ◽

10.1159/000441958 ◽

2015 ◽

Vol 235 (2) ◽

pp. 87-96

Author(s):

Jen-Chieh Lin ◽

Mei-Shu Lai

Keyword(s):

Diabetic Retinopathy ◽

Antihypertensive Drugs ◽

Angiotensin Receptor Blockers ◽

Incidence Rates ◽

Diabetic Patients ◽

Channel Blockers ◽

Type 2 Diabetic Patients ◽

Converting Enzyme Inhibitors ◽

Type 2 Diabetic

Objective: To evaluate the association between the development of sight-threatening diabetic retinopathy (STDR) and antihypertensive drugs (AHDs) use among type 2 diabetic patients with concomitant hypertension. Methods: Type 2 diabetic patients aged 20-100 years who had at least one prescription for AHDs between 2000 and 2011 were identified from the Longitudinal Health Insurance Database (LHID) 2005. The incidence rates of STDR were followed and Cox proportional hazard models were used to analyze the risk associated with AHDs. Results: Users of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) were associated with a significantly higher risk than users of calcium channel blockers (CCBs), independent of baseline characteristics. After adjusting for time-varying use of concomitant medications for propensity score-matched or -unmatched cohorts, the results showed that patients receiving ACEIs/ARBs and CCBs were associated with a significantly greater risk compared with β-blocker users. Conclusions: Our study did not support a superiority of ACEIs/ARBs and CCBs over β-blockers for lowering the progression of diabetic retinopathy.

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Intraoperative Hyperkalemia

Anesthesiology: A Problem-Based Learning Approach ◽

10.1093/med/9780190850692.003.0031 ◽

2018 ◽

pp. 269-274

Author(s):

M. Angele Theard ◽

Alexandra Bastien

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Enzyme Inhibitors ◽

Angiotensin Receptor Blockers ◽

Angiotensin Converting Enzyme Inhibitors ◽

Close Monitoring ◽

Converting Enzyme Inhibitors ◽

Renin Inhibitors ◽

Increased Risk ◽

Receptor Blockers

Patients with hypertension, diabetes, and heart disease are at risk for chronic kidney disease and therefore require close monitoring of potassium (K+) levels in order to avoid some of the more concerning consequences of hyperkalemia. Medical therapy in these patients, which often includes angiotensin converting enzyme inhibitors, angiotensin receptor blockers, renin inhibitors, and mineralocorticoid receptor antagonists, while helpful in managing some of the aforementioned comorbidities and ameliorating chronic kidney disease in these patients, places them at increased risk for unwanted K+ elevations. Symptoms of hyperkalemia maybe nonspecific (fatigue, weakness, and gastrointestinal upset), requiring attention therefore to preoperative laboratory analysis to avert the potentially lethal intraoperative consequences of hyperkalemia like asystole and ventricular fibrillation. Emergency surgery in these patients after trauma complicated by crush injury is particularly challenging requiring that the anesthesiologist be well-versed in recognizing the signs of and managing intraoperative hyperkalemia.

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Double trouble: combined cardiovascular effects of particulate matter exposure and coronavirus disease 2019

Cardiovascular Research ◽

10.1093/cvr/cvaa293 ◽

2020 ◽

Author(s):

Vineeta Tanwar ◽

Jeremy M Adelstein ◽

Loren E Wold

Keyword(s):

Particulate Matter ◽

Viral Infections ◽

Inflammatory Responses ◽

Angiotensin Receptor Blockers ◽

Cardiovascular Effects ◽

Air Pollutant ◽

The Body ◽

Experimental Investigations ◽

Cardiac Complications ◽

Converting Enzyme Inhibitors

Abstract The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly grown into a pandemic. According to initial reports, the lungs were thought to be the primary target, but recent case studies have shown its reach can extend to other organs including the heart and blood vessels. The severity of cardiac complications of COVID-19 depends on multiple underlying factors, with air pollutant exposure being one of them, as reported by several recent studies. Airborne particulate matter (PM) attracts heightened attention due to its implication in various diseases, especially respiratory and cardiovascular diseases. Inhaled PM not only carries microorganisms inside the body but also elicits local and systemic inflammatory responses resulting in altering the host’s immunity and increasing susceptibility to infection. Previous and recent studies have documented that PM acts as a ‘carrier’ for the virus and aids in spreading viral infections. This review presents the mechanisms and effects of viral entry and how pollution can potentially modulate pathophysiological processes in the heart. We aimed to concisely summarize studies examining cardiovascular outcomes in COVID-19 patients and postulate on how PM can influence these outcomes. We have also reviewed evidence on the use of renin–angiotensin system inhibitors, namely angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, in patients with COVID-19. The interplay of pollution and SARS-CoV-2 is essential to understanding the effects of accentuated cardiovascular effects of COVID-19 and deserves in-depth experimental investigations.

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