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Kelleni MT. Angiotensin receptor blockers could be superior to angiotensin-converting enzyme inhibitors in COVID-19 management: the potential role of bradykinin. Ir J Med Sci 2024; 193:2077-2078. [PMID: 38530555 DOI: 10.1007/s11845-024-03679-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 03/28/2024]
Affiliation(s)
- Mina T Kelleni
- Pharmacology Department, College of Medicine, Minia University, Minya, Egypt.
- Research Fellow INTI International University, Putra Nilai, Negeri Sembilan, Malaysia.
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Kumar S, Nikravesh M, Chukwuemeka U, Randazzo M, Flores P, Choday P, Raja A, Aseri M, Shivang S, Chaudhuri S, Barve P. Safety of ACEi and ARB in COVID-19 management: A retrospective analysis. Clin Cardiol 2022; 45:759-766. [PMID: 35481554 PMCID: PMC9110920 DOI: 10.1002/clc.23836] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 11/12/2022] Open
Abstract
Background & Aims Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV2)is a highly contagious virus that has infected 260 million individuals since December 2019. The severity of coronavirus disease 2019 (COVID‐19) depends upon the complex interplay between viral factors and the host's inflammatory response, which can trigger a cascadeeventually leading to multiorgan failure. There is contradictory evidence that angiotensin‐converting enzyme (ACEi) or angiotensin receptor blockers (ARBs) may affect mortality in patients with severe COVID‐19, theoretically due to interaction with the bradykinin pathway. Therefore, we aim to explore the association between ACEi and ARB use and mortality in severe SARS‐CoV2 infection.Severe acute respiratory yndrome with coronavirus (SARS‐CoV2) is a highly contagious virus that has infected 260 million individuals since December 2019. The severity of COVID‐19 depends upon the complex interplay between viral factors and the host's inflammatory response, which can trigger a cascadeeventually leading to multiorgan failure. There is contradictory evidence that angiotensin‐converting enzyme (ACEi) or angiotensin receptor blockers (ARBs) may affect mortality in patients with severe COVID‐19, theoretically due to interaction with the bradykinin pathway. Therefore, we aim to explore the association between ACEi and ARB use and mortality in severe SARS‐CoV2 infection. Materials & Methodology This multicenter retrospective observational study enrolled 2935 COVID‐19 patients admitted at six hospitals in Southern California, USA, between March 2020 and August 2021. Our primary outcome was the association of pre‐hospital use of ACEi and ARB on in‐hospital mortality in COVID‐19 patients. First, relevant deidentified patient data were extracted using an SQL program from the electronic medical record. Then, a bivariate analysis of the relationship between ACEi and ARB use and different study variables using χ2 and t test was done. Finally, we did a backward selection Cox multivariate regression analysis using mortality as a dependent variable. Results Of the 2935 patients in the study, hypertension was present in 40.6%, and congestive heart failure in 13.8%. ACEi and ARB were used by 17.5% and 11.3% of patients, respectively, with 28.8% of patients on either medication. After adjusting for confounding variables in the multivariate analysis, the use of ACEi (HR: 1.226, 95% CI: 0.989–1.520) or ARB (HR: 0.923, 95% CI: 0.701–1.216) was not independently associated with increased mortality. Conclusion Our results are consistent with the clinical guidelines and position statements per the International Society of Hypertension, that there is no indication to stop the use of ACEi/ARB in COVID‐19 patients.
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Affiliation(s)
- Sabina Kumar
- Department of Internal Medicine, Hemet Global Medical Center, Hemet, California, USA
| | - Mastaneh Nikravesh
- Department of Internal Medicine, Hemet Global Medical Center, Hemet, California, USA
| | - Umeh Chukwuemeka
- Department of Internal Medicine, Hemet Global Medical Center, Hemet, California, USA
| | - Michael Randazzo
- Department of Internal Medicine, Hemet Global Medical Center, Hemet, California, USA
| | - Peter Flores
- Department of Internal Medicine, Hemet Global Medical Center, Hemet, California, USA
| | - Prithi Choday
- Department of Internal Medicine, Hemet Global Medical Center, Hemet, California, USA
| | - Ajith Raja
- Department of Internal Medicine, Hemet Global Medical Center, Hemet, California, USA
| | - Mahendra Aseri
- Department of Internal Medicine, Hemet Global Medical Center, Hemet, California, USA
| | - Shah Shivang
- Divison of Cardiology, Loma Linda University School of Medicine, Loma Linda, California, USA.,Division of Cardiology, University of California Riverside School of Medicine, Riverside, California, USA
| | - Sumanta Chaudhuri
- Department of Internal Medicine, Hemet Global Medical Center, Hemet, California, USA
| | - Pranav Barve
- Department of Internal Medicine, Hemet Global Medical Center, Hemet, California, USA
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