Angiotensin converting enzymes inhibitors or angiotensin receptor blockers should be continued in COVID-19 patients with hypertension

doi:10.12998/wjcc.v9.i1.47

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World Journal of Clinical Cases

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World J Clin Cases. Jan 6, 2021; 9(1): 47-60
Published online Jan 6, 2021. doi: 10.12998/wjcc.v9.i1.47

Angiotensin converting enzymes inhibitors or angiotensin receptor blockers should be continued in COVID-19 patients with hypertension

Ci Tian, Nan Li, Yi Bai, Han Xiao, Shu Li, Qing-Gang Ge, Ning Shen, Qing-Bian Ma

Ci Tian, Yi Bai, Shu Li, Qing-Bian Ma, Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China

Nan Li, Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China

Han Xiao, Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing 100191, China

Qing-Gang Ge, Department of Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China

Ning Shen, Department of Pulmonary and Critical Care Medicine, Department of Medicine, Peking University Third Hospital, Beijing 100191, China

Author contributions: Tian C conceived and designed the study; Tian C and Bai Y collected the data of this study; Li N performed the data analysis; Tian C wrote the manuscript; Li S reviewed and edited the manuscript; Ma QB designed research; all authors read and approved the manuscript. Tian C, Li N and Bai Y contributed equally to the manuscript.

Institutional review board statement: This study was approved by Institutional Review Board of Peking University Third Hospital, China (No. IRB00006761-M2020060).

Informed consent statement: The study was approved by Institutional Review Board of Peking University Third Hospital and got waiver of written informed consent.

Conflict-of-interest statement: The authors declare that there is no conflict of interest.

Data sharing statement: The data used to support the findings of this study are available from the corresponding author upon request.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Corresponding author: Qing-Bian Ma, MD, Associate Professor, Chairman, Chief Physician, Department of Emergency Medicine, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China. maqingbian@bjmu.edu.cn

Received: October 9, 2020
Peer-review started: October 9, 2020
First decision: November 3, 2020
Revised: November 9, 2020
Accepted: November 21, 2020
Article in press: November 21, 2020
Published online: January 6, 2021
Processing time: 84 Days and 3.3 Hours

ARTICLE HIGHLIGHTS

Research background

During the coronavirus disease 2019 (COVID-19) pandemic, several studies have revealed that sustained ingestion of angiotensin converting enzymes inhibitors or angiotensin receptor blockers (ACEIs/ARBs) had no harmful effects on COVID-19 patients complicated with hypertension.

Research motivation

The role of angiotensin converting enzyme-2 (ACE2) receptor in COVID-19 pathophysiological process remains unclear. We expect to provide more important evidence for ACEIs/ARBs usage in clinical application.

Research objectives

To explore the impact of ACEIs/ARBs discontinued usage on COVID-19 patients complicated with hypertension.

Research methods

This study was based on a COVID-19 cohort from a patient registry of all COVID-19 patients admitted to an isolated unit in a tertiary hospital. All COVID-19 patients complicated with hypertension were recruited in our study and divided into discontinued ACEIs/ARBs group or other anti-hypertensive drugs group. We compared characteristics and clinical outcomes between those two different groups of patients.

Research results

A total of 53 patients were enrolled, 27 patients switched from ACEIs/ARBs to CCBs while 26 patients continued with non-ACEIs/ARBs. After controlling potential confounding factors using the Cox proportional hazards model, hospital stay was longer in patients who discontinued ACEIs/ARBs, with a hazard ratio (HR) of 0.424 [95% confidence interval (CI): 0.187-0.962; P = 0.040], than in patients using other anti-hypertensive drugs. A sub-group analysis showed that the effect of discontinuing ACEIs/ARBs was stronger in moderate cases [HR = 0.224 (95%CI: 0.005-0.998; P = 0.0497)].

Research conclusions

Our data revealed that discontinuing ACEIs/ARBs treatment after COVID-19 diagnosis results in a prolonged hospital stay. This phenomenon was more significant in hospitalized patients with moderate COVID-19. Our research suggested that ACEIs/ARBs should be continued in patients with both COVID-19 and hypertension unless further evidence demonstrates adverse outcomes.

Research perspectives

The mechanism of ACE2 in COVID-19 patients complicated with hypertension remains unclear and may be more complex, requiring further research to explore this area in the future.