Abstract
Coronavirus disease (COVID-19) patients with cardiovascular and metabolic disorders have been found to have a high risk of developing severe conditions with high mortality, further affecting the prognosis of COVID-19. However, the effect of hypertension and angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blocker (ARB) agents on the clinical characteristics and inflammatory immune responses in COVID-19 patients is still undefined. In this study, 90 COVID-19 patients were divided into hypertension and nonhypertension groups. The hypertension group was divided into well-controlled and poorly controlled subgroups based on blood pressure levels; moreover, hypertensive patients were also divided into ACEI/ARB and non-ACEI/ARB subgroups according to the administration of ACEI/ARB antihypertensive agents. The clinical characteristics of and inflammatory immune biomarker levels in the different groups of COVID-19 patients were compared, and the association between the combined effect of hypertension with ACEI/ARB antihypertensive agents and the severity of COVID-19 was examined. The results showed that the levels of aminotransferase (AST) and hs-cTnI were higher in the hypertension group compared with the nonhypertension group. The long-term use of ACEI/ARB agents in patients had statistically significantly lower AST, low-density lipoprotein cholesterol (LDL-C), and oxygen uptake and lower white cell count, neutrophil count, and levels of CD4, CD8, CRP, and PCT but without statistical significance. In addition, compared with COVID-19 patients without hypertension, hypertensive patients without the use of ACEI/ARB had a higher risk of developing severity of COVID-19 (for poorly controlled patients: OR = 3.97, 95% CI = 1.03–15.30; for well-controlled patients: OR = 6.48, 95% CI = 1.77–23.81). Hypertension could cause organ damage in COVID-19 patients, but the long-term use of ACEI/ARB agents may be beneficial to alleviate this injury.
Highlights
Coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
This study provided additional evidence for the beneficial effects of angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blocker (ARB) agents on COVID-19 in patients with hypertension
Hospital admission varied from February 15, 2020, to February 28, 2020, and information on all cases was recorded on March 14, 2020.COVID-19 was diagnosed based on the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia released by the National Health Commission of the PRC (Wei, 2020)
Summary
Coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It has developed into a high-risk pandemic that has affected the global population. COVID-19 patients with cardiovascular conditions, especially hypertension, have been reported to be at a high risk of developing severe conditions and mortality, in turn affecting the prognosis of COVID-19 (Chen et al, 2020; Zhou et al, 2020; Li et al, 2020; Leung, 2020). The angiotensin-converting enzyme 2 receptor (ACE2 receptor) in the RAAS is considered to play an important role. ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are widely used as antihypertensive drugs, which can enhance ACE2 expression (Gottlieb et al, 1993; Bauer et al, 1995). Arbitrarily adjusting the use of antihypertensive drugs is not recommended (Esler and Esler, 2020)
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