Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2021; 9(20): 5462-5469
Published online Jul 16, 2021. doi: 10.12998/wjcc.v9.i20.5462
Effects of angiotensin receptor blockers and angiotensin-converting enzyme inhibitors on COVID-19
Xiao-Long Li, Tao Li, Qi-Cong Du, Li Yang, Kun-Lun He
Xiao-Long Li, Department of Diagnostic Radiology, PLA General Hospital, Beijing 100853, China
Tao Li, Li Yang, Department of Radiology, The First Medical Center of PLA General Hospital, Beijing 100853, China
Qi-Cong Du, Department of Diagnostic Radiology, The First Medical Center of PLA General Hospital, Beijing 100853, China
Kun-Lun He, Translational Medical Research Center, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Medical Innovation Research Division of Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Li XL, Li T and Du QC contribute equally to this article and should be considered as co-first authors; Li XL and Du QC performed the operation; Li XL and He KL designed this retrospective study; Du QC and Yang L wrote this paper; Li T was responsible for sorting the data.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Huoshenshan Hospital, Wuhan, China (Approval No. HSSLL019).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kun-Lun He, MD, Chief Physician, Translational Medical Research Center, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Medical Innovation Research Division of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. kunlunhe@plagh.org
Received: April 6, 2021
Peer-review started: April 6, 2021
First decision: April 28, 2021
Revised: April 30, 2021
Accepted: May 24, 2021
Article in press: May 24, 2021
Published online: July 16, 2021
ARTICLE HIGHLIGHTS
Research background

The World Health Organization reported that 28637952 people worldwide had been infected with severe acute respiratory syndrome coronavirus 2, the causative agent of coronavirus disease 2019 (COVID-19), by September 13.

Research motivation

Some investigators believe that the use of RAAS inhibitors by COVID-19 patients with hypertension aggravates COVID-19. Some also believe that angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors can inhibit the activity of the RAAS and as well as the progression of respiratory injury, thus playing a protective role in COVID-19 patients. However, those assumptions are based on animal experiments and lack clinical evidence. This study intended to resolve whether the use of RAAS inhibitors by COVID-19 patients with hypertension aggravated their degree of pneumonia.

Research objectives

The objective was to investigate whether long-term treatment with RAAS inhibitors aggravated the performance of COVID-19 patients with hypertension.

Research methods

This was a retrospective analysis of lung computed tomography (CT) data and laboratory values of COVID-19 patients with hypertension who were admitted to Huoshenshan Hospital, Wuhan, Hubei Province, between February 18 and March 31, 2020. Patients were divided into two groups. Group A included 19 people who were long-term users of RAAS inhibitors for hypertension and group B included 28 people who were randomly selected from the patient database and matched with group A by age, sex, other diseases, and long-term use of other antihypertensive drugs. All patients underwent a series of CT and laboratory tests. We compared the most severe CT images of the two groups and the laboratory examination results within 2 d of obtaining the corresponding CT images.

Research results

Chest CT is an important imaging tool to monitor the characteristics of COVID-19 and the degree of lung injury. Chronic use of RAAS inhibitors was not related to the severity of COVID-19, and they did not worsen the clinical course.

Research conclusions

The clinical responses to the long-term treatment of hypertensive COVID-19 patients with ACE inhibitors and ARBs did not worsen their pneumonia. Chest CT is an important imaging method to monitor the characteristics of COVID-19 and the degree of lung involvement. This study showed that the most serious chest CT signs and chest CT scores of lung involvement were not significantly different between COVID-19 patients with hypertension treated with ACE inhibitors and ARBs and COVID-19 patients treated with other antihypertensive drugs. Animal experiments show that intravenous administration of ACE inhibitors and/or ARBs upregulates ACE2, thus worsening the clinical course of COVID-19. Clinical studies have shown that ACE inhibitors and ARBs may play a protective role against pneumonia This study showed that there were no significant differences in routine blood values, C-reactive protein, myocardial enzyme activity, liver function, renal function, chest CT pneumonia characteristics, or lung CT scores between COVID-19 patients treated with ACE inhibitors and ARBs and COVID-19 patients treated with other antihypertensive drugs. The results are consistent with recent studies finding that the use of ACE inhibitors and ARBs had nothing to do with the severity of COVID-19.

Research perspectives

This study has two shortcomings: (1) The sample size was small and may be biased; and (2) It was a short-term retrospective study. We performed few preliminary exploratory evaluations. In addition, some patients had residual lung lesions when they met the discharge criteria. The best perspective for future research is to conduct that long-term follow-up of large samples to monitor the outcome of pulmonary lesions.