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Yoshihara F, Matsuzawa Y, Nakatsuka K, Kirigaya J, Takeuchi I, Kimura K, Konishi M, Tamura K, Fukui K, Tsukahara K, Shimizu H, Iwabuchi K, Yamada Y, Saka K, Sato Y, Ogawa M, Hayakawa K, Ohmagari N, Ikeda S, Akao M, Shimomura H, Kihara Y, Yoshimoto A, Morita M, Kumada N, Ogata S, Nishimura K, Arisato T, Matsuo M, Kishida M, Yasuda S, Ogawa H. Relationship between 2nd-generation angiotensin receptor blockers and the risk of hypotension in COVID-19 patients admitted to hospital. Hypertens Res 2024; 47:1943-1951. [PMID: 38664510 DOI: 10.1038/s41440-024-01682-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 03/04/2024] [Accepted: 03/31/2024] [Indexed: 07/03/2024]
Abstract
It has not yet been established whether angiotensin II receptor blockers (ARB), statins, and multiple drugs affect the severity of COVID-19. Therefore, we herein performed an observational study on the effects of 1st- and 2nd-generation ARB, statins, and multiple drugs, on COVID-19 in patients admitted to 15 Japanese medical facilities. The results obtained showed that ARB, statins, and multiple drugs were not associated with the primary outcome (odds ratio: 1.040, 95% confidence interval: 0.688-0.571; 0.696, 0.439-1.103; 1.056, 0.941-1.185, respectively), each component of the primary outcome (in-hospital death, ventilator support, extracorporeal membrane oxygenation support, and admission to the intensive care unit), or the secondary outcomes (oxygen administration, disturbed consciousness, and hypotension, defined as systolic blood pressure ≤90 mmHg). ARB were divided into 1st- and 2nd-generations based on their approval for use (before 2000 and after 2001), with the former consisting of losartan, candesartan, and valsartan, and the latter of telmisartan, olmesartan, irbesartan, and azilsartan. The difference of ARB generation was not associated with the primary outcome (odds ratio with 2nd-generation ARB relative to 1st-generation ARB: 1.257, 95% confidence interval: 0.613-2.574). The odd ratio for a hypotension as one of the secondary outcomes with 2nd-generation ARB was 1.754 (95% confidence interval: 1.745-1.763) relative to 1st-generation ARB. These results suggest that patients taking 2nd-generation ARB may be at a higher risk of hypotension than those taking 1st-generation ARB and also that careful observations are needed. Further studies are continuously needed to support decisions to adjust medications for co-morbidities.
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Affiliation(s)
- Fumiki Yoshihara
- Division of Nephrology and Hypertension, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Yasushi Matsuzawa
- Division of Cardiology, Yokohama City University Medical Center, Yokohama city, Japan
- Department of Cardiovascular Medicine, Kumamoto University Hospital, Kumamoto, Japan
| | - Kiyomasa Nakatsuka
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Osaka, Japan
| | - Jin Kirigaya
- Division of Cardiology, Yokohama City University Medical Center, Yokohama city, Japan
| | - Ichiro Takeuchi
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama City, Japan
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Yokohama city, Japan
| | - Masaaki Konishi
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kazuki Fukui
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Kengo Tsukahara
- Division of Cardiology, Fujisawa City Hospital, Fujisawa, Japan
| | - Hiroyuki Shimizu
- Department of Clinical Laboratory Medicine, Fujisawa City Hospital, Fujisawa, Japan
| | - Keisuke Iwabuchi
- Department of General Medicine, Kanagawa Prefectural Ashigarakami Hospital, Ashigara, Japan
| | - Yu Yamada
- Division of Cardiology, Kanagawa Prefectural Ashigarakami Hospital, Ashigara, Japan
| | - Kenichiro Saka
- Division of Cardiology, Yokosuka City Hospital, Yokosuka, Japan
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Masahiro Ogawa
- Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan
| | - Kayoko Hayakawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Syuhei Ikeda
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, Japan
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, Japan
| | - Hideki Shimomura
- Division of Cardiology, Fukuoka Tokushukai Hospital, Fukuoka, Japan
| | - Yasuki Kihara
- Kobe City Medical Center General Hospital, 2-1-1, Minamimachi, Minatojima, Chuoku, Kobe, Hyogo, Japan
| | - Akihiro Yoshimoto
- Department of Nephrology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Masanori Morita
- Critical Care Medical Center Sakai City Medical Center, Sakai, Japan
| | - Norihiko Kumada
- Department of Urology, Suita Municipal Hospital, Suita, Japan
| | - Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Osaka, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Osaka, Japan
| | - Tetsuya Arisato
- Division of Nephrology and Hypertension, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Miki Matsuo
- Division of Nephrology and Hypertension, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masatsugu Kishida
- Division of Nephrology and Hypertension, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Zhang K, Gao H, Chen M. Association of antihypertensive drugs with COVID-19 outcomes: a drug-target Mendelian randomization study. Front Pharmacol 2023; 14:1224737. [PMID: 38116083 PMCID: PMC10728283 DOI: 10.3389/fphar.2023.1224737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
Background: Observational investigations have provided conflicting results regarding the effect of antihypertensive drugs on the risk of COVID-19 outcomes. We intended to assess the causal effect of antihypertensive drugs on COVID-19 outcomes using drug-target Mendelian randomization (MR), mainly including angiotensin-converting enzyme inhibitors (ACEIs), β-blockers (BBs) and calcium channel blockers (CCBs). Methods: We used the genetic variants (minor allele frequency >1%, r 2 < 0.30) located within 100 k bases of each drug target gene and associated with lower systolic blood pressure (p < 5 × 10-8) as genetic proxies for antihypertensive drugs. COVID-19 outcomes included COVID-19 susceptibility (122,616 cases and 2,475,240 controls), hospitalization (32,519 cases and 206,2805 controls), and severe illness (13,769 cases and 1,072,442 controls). All studies were conducted on populations of European ancestry. MR estimates were generated using an inverse variance weighted (IVW) model. Results: IVW-MR analysis observed a weak causality between CCBs and COVID-19 susceptibility (OR: 0.993, 95% CI: 0.988-0.999, p = 0.012). Sensitivity analysis suggested that this result was robust. No evidence was found for a link between other antihypertensive drugs and COVID-19 outcomes. Conclusion: The present study suggests that CCBs may reduce COVID-19 susceptibility in European populations.
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Affiliation(s)
| | | | - Mingwei Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
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Alhallak I, Paydak H, Mehta JL. Prior Statin vs In-Hospital Statin Usage in Severe COVID-19: Review and Meta-Analysis. Curr Probl Cardiol 2023:101810. [PMID: 37211301 PMCID: PMC10198742 DOI: 10.1016/j.cpcardiol.2023.101810] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/23/2023]
Abstract
Studies have shown that statins can decrease COVID-19 mortality in hospitalized patients. This paper evaluates these studies and reviews the possible mechanism of how statins modulate COVID-19 severity. Meta-analysis of 31 retrospective studies demonstrated a reduction in mortality rate among statin users (OR 0.69, 95% CI 0.56-0.86, p =0.0008) (HR 0.83, 95% CI 0.72-0.95, p =0.0078). Meta-analysis of 8 randomized control studies demonstrated a nonsignificant reduction in mortality (OR 0.90, 95% CI 0.69-1.18, p =0.461), including four studies with medications other than statins, and four studies with only statins (OR 0.88, 95% CI 95% CI 0.64-1.21, p =0.423). Prolonged statin usage decreases the extracellular localization of ACE2, along with statins' immunomodulating effects and reduction of oxidative stress, decreases COVID-19 mortality. Hospitalized patients with COVID-19 should continue statin treatment if previously prescribed, and patients should not be started on statins, as they do not seem to provide any mortality benefit.
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Affiliation(s)
- Iad Alhallak
- Department of Cardiology, University of Arkansas for Medical Sciences and the Veterans Affairs Medical Center, Little Rock, AR 72205, USA
| | - Hakan Paydak
- Department of Cardiology, University of Arkansas for Medical Sciences and the Veterans Affairs Medical Center, Little Rock, AR 72205, USA
| | - Jawahar L Mehta
- Department of Cardiology, University of Arkansas for Medical Sciences and the Veterans Affairs Medical Center, Little Rock, AR 72205, USA.
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Dutsch A, Schunkert H. RAAS inhibition and beyond-cardiovascular medications in patients at risk of or affected by COVID-19. Herz 2023:10.1007/s00059-023-05168-4. [PMID: 37097476 PMCID: PMC10127983 DOI: 10.1007/s00059-023-05168-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 04/26/2023]
Abstract
The COVID-19 pandemic led to an enormous burden on healthcare systems worldwide. Causal therapy is still in its infancy. Contrary to initial views that the use of angiotensin-converting enzyme inhibitors (ACEi)/angiotensin II receptor blockers (ARBs) may increase the risk for a deleterious disease course, it has been shown that these agents may actually be beneficial for patients affected by COVID-19. In this article, we provide an overview of the three most commonly used classes of drugs in cardiovascular disease (ACEi/ARB, statins, beta-blockers) and their potential role in COVID-19 therapy. More results from randomized clinical trials are necessary to identify patients that can benefit most from the use of the respective drugs.
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Affiliation(s)
- Alexander Dutsch
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, 80636, Munich, Germany
- DZHK e. V. (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, 80636, Munich, Germany.
- DZHK e. V. (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Munich, Germany.
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Vilaplana-Carnerero C, Giner-Soriano M, Dominguez À, Morros R, Pericas C, Álamo-Junquera D, Toledo D, Gallego C, Redondo A, Grau M. Atherosclerosis, Cardiovascular Disease, and COVID-19: A Narrative Review. Biomedicines 2023; 11:biomedicines11041206. [PMID: 37189823 DOI: 10.3390/biomedicines11041206] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023] Open
Abstract
Atherosclerosis is a chronic inflammatory and degenerative process that mainly occurs in large- and medium-sized arteries and is morphologically characterized by asymmetric focal thickenings of the innermost layer of the artery, the intima. This process is the basis of cardiovascular diseases (CVDs), the most common cause of death worldwide. Some studies suggest a bidirectional link between atherosclerosis and the consequent CVD with COVID-19. The aims of this narrative review are (1) to provide an overview of the most recent studies that point out a bidirectional relation between COVID-19 and atherosclerosis and (2) to summarize the impact of cardiovascular drugs on COVID-19 outcomes. A growing body of evidence shows that COVID-19 prognosis in individuals with CVD is worse compared with those without. Moreover, various studies have reported the emergence of newly diagnosed patients with CVD after COVID-19. The most common treatments for CVD may influence COVID-19 outcomes. Thus, their implication in the infection process is briefly discussed in this review. A better understanding of the link among atherosclerosis, CVD, and COVID-19 could proactively identify risk factors and, as a result, develop strategies to improve the prognosis for these patients.
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Affiliation(s)
- Carles Vilaplana-Carnerero
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
- Department of Medicine, School of Medicine and Health Sciences, University of Barcelona, 08036 Barcelona, Spain
- School of Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Maria Giner-Soriano
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
- School of Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Àngela Dominguez
- Department of Medicine, School of Medicine and Health Sciences, University of Barcelona, 08036 Barcelona, Spain
- Biomedical Research Consortium in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Rosa Morros
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
- Biomedical Research Consortium in Infectious Diseases (CIBERINFEC), 28029 Madrid, Spain
- Department of Pharmacology, Therapeutics and Toxicology, School of Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Carles Pericas
- Department of Medicine, School of Medicine and Health Sciences, University of Barcelona, 08036 Barcelona, Spain
- Epidemiology Service, Public Health Agency of Barcelona (ASPB), 08023 Barcelona, Spain
| | - Dolores Álamo-Junquera
- Department of Medicine, School of Medicine and Health Sciences, University of Barcelona, 08036 Barcelona, Spain
- Quality, Process and Innovation Direction, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
- Health Services Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
| | - Diana Toledo
- Department of Medicine, School of Medicine and Health Sciences, University of Barcelona, 08036 Barcelona, Spain
- Biomedical Research Consortium in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Carmen Gallego
- Department of Medicine, School of Medicine and Health Sciences, University of Barcelona, 08036 Barcelona, Spain
- Methodology, Quality and Medical Care Assessment Department, Direcció d'Atenció Primària Metropolitana Sud, Catalan Institute of Health (ICS), 08908 Barcelona, Spain
| | - Ana Redondo
- Hospital Universitario Bellvitge, Catalan Institute of Health (ICS), 08907 Barcelona, Spain
| | - María Grau
- Biomedical Research Consortium in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Serra Húnter Fellow, Department of Medicine, School of Medicine and Health Sciences, University of Barcelona, 08036 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
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