Is the use of ACEI, ARB linked to a positive COVID-19 test?

New research published in prestigious journals JAMA Cardiology In May 2020, we reported that there was no association between the use of ACEI / ARB and a positive COVID-19 test. This supports current medical advice to continue the use of these drugs regardless of ongoing pandemics, but the need for further research to rule out the additional risk of seriousness from these drugs. Shows sex.

A current study of the Cleveland Clinic Health System investigated COVID-19 test results and the impact of angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) on disease severity and clinical outcome. The study found no significant association between ACEI or ARB use and positive COVID-19 tests.

To date, ACEI and ARB have been prescribed for the management of chronic diseases such as high blood pressure and heart disease. However, in light of the recent COVID-19 pandemic, some researchers fear that their use may exacerbate the symptoms of the disease. It is based on data from animal studies and has been shown that ACEI and ARB enhance expression of the membrane-bound angiotensin converting enzyme 2 (ACE2), a viral receptor in human cells.

SARS-CoV-2 virus that binds to ACE2 receptor in human cells, early stage of COVID-19 infection, Illustration credit: Kateryna Kon / Shutterstock

By allowing the entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) into cells, these drugs could theoretically increase the risk of severity in COVID-19 patients. .

On the other hand, Angiotensin II is converted to Angiotensin (1-7). Angiotensin has potential vasodilatory and anti-inflammatory effects via ACE2 binding. In this case, up-regulation of ACE2 is seen as a potential benefit for COVID-19 patients.

Withdrawals can be harmful in certain high-risk patients, and the expert association recommends that those already taking these drugs continue to take them. The clinical evidence for either approach is inadequate at this time.

How was the research done?

A retrospective cohort study was conducted in the Cleveland Clinic Health Systems in Ohio and Florida, including all patients tested for COVID-19 from March 8, 2020 to April 12, 2020. This study investigated the feasibility of testing ACEI or ARB users, SARS-CoV-2 infections, and their admission, assessed by the requirements of mechanical ventilation during hospitalization, ICU admission, and patients’ first admission. Positive for clinical disease outcome.

A total of 18,472 patients tested for SARS-CoV-2 were included, with an average age of 49 years. Of those, 1,322 were taking ACEI and 982 were taking ARB-combined, about 12% of the population tested used either ACEI or ARB. Most of the population tested had comorbidities such as high blood pressure, coronary artery disease, chronic, obstructive pulmonary disease, and heart failure.

Of the 18,472 patients tested with SARS-CoV-2, 1735 patients were positive. Of these, 116 were taking ACEI and 98 were taking ARB or approximately 12%.

Do these drugs increase the likelihood of illness or more serious illnesses?

The researchers say that taking either ACEI or ARB did not increase the likelihood of testing positive for SARS-CoV-2 infection. After adjusting for confounding factors, the test-positive rates of patients using these drugs were 8.6% and 10%, respectively, in patients using ACEI and ARB, but not using these drugs In patients, 9.5% and 9.3%.

The initial unadjusted analysis showed that patients taking either ACEI or ARB had worse clinical outcomes, but researchers often find that the drug is prescribed for the underlying underlying chronic condition. Pointed out that the risk of disease severity increases.

Further analysis showed that patients who were using ACEI or ARB were more likely to be hospitalized. Patients taking ACEI are reportedly more likely to be admitted to the ICU. However, ARB use was not associated with increased ICU hospitalization. Neither ACEI nor ARB use was associated with an increased need for mechanical ventilation during the hospitalization episode included in the study.

What does research mean?

The researchers warned that the findings could not be generalized on a large scale because of research limitations and recommended a further study of the effects of drugs on disease outcomes with larger data sets.

They concluded that the findings seem to support the recommendations of various professional bodies, which recommend continued use of the drug, especially for people with chronic illnesses.

“At this time, there is no compelling evidence that ACEI / ARB affects the human transmembrane ACE2 receptor that predisposes to COVID-19 infection,” the study said.