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Felice C, Nardin C, Di Tanna GL, Grossi U, Bernardi E, Scaldaferri L, Romagnoli M, Tonon L, Cavasin P, Novello S, Scarpa R, Farnia A, De Menis E, Rigoli R, Cinetto F, Pauletto P, Agostini C, Rattazzi M. Use of RAAS Inhibitors and Risk of Clinical Deterioration in COVID-19: Results From an Italian Cohort of 133 Hypertensives. Am J Hypertens 2020; 33:944-948. [PMID: 32511678 PMCID: PMC7314218 DOI: 10.1093/ajh/hpaa096] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/05/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The effect of chronic use of renin-angiotensin-aldosterone system (RAAS) inhibitors on the severity of COVID-19 infection is still unclear in patients with hypertension. We aimed to investigate the association between chronic use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) and COVID-19-related outcomes in hypertensive patients. METHODS A single-center study was conducted on 133 consecutive hypertensive subjects presenting to the emergency department with acute respiratory symptoms and/or fever who were diagnosed with COVID-19 infection between 9 and 31 March 2020. RESULTS All patients were grouped according to their chronic antihypertensive medications (ACEIs, N = 40; ARBs, N = 42; not on RAAS inhibitors, N = 51). There was no statistical difference between ACEIs and ARBs groups in terms of hospital admission rate, oxygen therapy, and need for noninvasive ventilation. Patients chronically treated with RAAS inhibitors showed a significantly lower rate of admission to semi-intensive/intensive care units, when compared with the non-RAAS population (odds ratio (OR) 0.25, confidence interval (CI) 95% 0.09-0.66, P = 0.006). Similarly, the risk of mortality was lower in the former group, although not reaching statistical significance (OR 0.56, CI 95% 0.17-1.83, P = 0.341). CONCLUSIONS Our data suggest that chronic use of RAAS inhibitors does not negatively affect clinical course of COVID-19 in hypertensive patients. Further studies are needed to confirm this finding and determine whether RAAS inhibitors may have a protective effect on COVID-19-related morbidity and mortality.
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Affiliation(s)
- Carla Felice
- Acute and Emergency Department, Ca’ Foncello Hospital, Treviso, Italy
- Department of Medicine—DIMED, Medicina Generale I^, Ca’ Foncello Hospital, Treviso, University of Padova, Padua, Italy
| | - Chiara Nardin
- Department of Medicine—DIMED, Medicina Generale I^, Ca’ Foncello Hospital, Treviso, University of Padova, Padua, Italy
| | - Gian Luca Di Tanna
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Ugo Grossi
- Department of Surgical, Oncologic and Gastroenterological Sciences (DISCOG), Ca’ Foncello Hospital, Treviso, University of Padua, Padua, Italy
| | - Enrico Bernardi
- Acute and Emergency Department, Ca’ Foncello Hospital, Treviso, Italy
| | - Luca Scaldaferri
- Acute and Emergency Department, Ca’ Foncello Hospital, Treviso, Italy
| | - Micaela Romagnoli
- Department of Specialistic and Laboratory Medicine Pulmonology Unit, Ca’ Foncello Hospital, Treviso, Italy
| | - Luca Tonon
- Department of Medicine—DIMED, Medicina Generale I^, Ca’ Foncello Hospital, Treviso, University of Padova, Padua, Italy
| | - Paola Cavasin
- Department of Medicine—DIMED, Medicina Generale I^, Ca’ Foncello Hospital, Treviso, University of Padova, Padua, Italy
| | - Simone Novello
- Department of Surgical, Oncologic and Gastroenterological Sciences (DISCOG), Ca’ Foncello Hospital, Treviso, University of Padua, Padua, Italy
| | - Riccardo Scarpa
- Department of Medicine—DIMED, Medicina Generale I^, Ca’ Foncello Hospital, Treviso, University of Padova, Padua, Italy
| | - Antonio Farnia
- Department of Anesthesia and Intensive Care, Ca’ Foncello Hospital, Treviso, Italy
| | - Ernesto De Menis
- Department of Medicine, Medicina Generale II^, Ca’ Foncello Hospital, Treviso, Italy
| | - Roberto Rigoli
- Department of Specialistic and Laboratory Medicine, Microbiology Unit, Ca’ Foncello Hospital, Treviso, Italy
| | - Francesco Cinetto
- Department of Medicine—DIMED, Medicina Generale I^, Ca’ Foncello Hospital, Treviso, University of Padova, Padua, Italy
| | - Paolo Pauletto
- O.R.A.S. SpA, Ospedale Riabilitativo di Alta Specializzazione, Motta Di Livenza, Italy
| | - Carlo Agostini
- Department of Medicine—DIMED, Medicina Generale I^, Ca’ Foncello Hospital, Treviso, University of Padova, Padua, Italy
| | - Marcello Rattazzi
- Department of Medicine—DIMED, Medicina Generale I^, Ca’ Foncello Hospital, Treviso, University of Padova, Padua, Italy
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Aleksova A, Ferro F, Gagno G, Cappelletto C, Santon D, Rossi M, Ippolito G, Zumla A, Beltrami AP, Sinagra G. COVID-19 and renin-angiotensin system inhibition: role of angiotensin converting enzyme 2 (ACE2) - Is there any scientific evidence for controversy? J Intern Med 2020; 288:410-421. [PMID: 32459372 PMCID: PMC7283873 DOI: 10.1111/joim.13101] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 12/15/2022]
Abstract
Renin-angiotensin system (RAS) blockers are extensively used worldwide to treat many cardiovascular disorders, where they are effective in reducing both mortality and morbidity. These drugs are known to induce an increased expression of angiotensin-converting enzyme 2 (ACE2). ACE2 acts as receptor for the novel SARS coronavirus-2 (SARS-CoV-2) which raising the important issue of possible detrimental effects that RAS blockers could exert on the natural history and pathogenesis of the coronavirus disease-19 (COVID-19) and associated excessive inflammation, myocarditis and cardiac arrhythmias. We review the current knowledge on the interaction between SARS-CoV-2 infection and RAS blockers and suggest a scientific rationale for continuing RAS blockers therapy in patients with COVID-19 infection.
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Affiliation(s)
- A Aleksova
- From the, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - F Ferro
- From the, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - G Gagno
- From the, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - C Cappelletto
- From the, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - D Santon
- From the, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - M Rossi
- From the, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - G Ippolito
- National Institute for Infectious Diseases Lazzaro Spallanzani - IRCCS, Rome, Italy
| | - A Zumla
- Division of Infection and Immunity, University College London, London, UK.,National Institute of Health Research, Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - G Sinagra
- From the, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
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