Case Series
Volume 3 Issue 11 - 2020
Use of Renin-Angiotensin System Inhibitors in Hypertensive Patients in COVID-19 Era: A Review
Aisha Hasan1, Mohsin Ali2, Shahzeb Irfan Malik2, Mohammad Haroon Hassan2, Manpreet Singh Kala3, Tooba Ali4, Muhammad Jahangir Iftikhar5 and Nadeem Iqbal6*
1Avicenna Medical College, Lahore, Pakistan
2Shifa College of Medicine, Islamabad, Pakistan
3Navale Medical College and Hospital, Pune, India
4Gujranwala Medical College, Gujranwala, Pakistan
5Mid Essex University Hospital, NHS, UK
6Department of Urology, Pakistan Kidney and Liver Institute, Pakistan
*Corresponding Author: Nadeem Iqbal, Department of Urology and Kidney Transplant, Pakistan Kidney and Liver Institute, Pakistan.
Received: October 08, 2020; Published: October 19, 2020




Abstract

The presentation of COVID-19, caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2), has largely been asymptomatic or mild in youngsters and the pediatric age group. The elderly population, however, have been at a much higher risk of severe disease wtih grave complications and even death. Furthermore, obseity, cardiovascular ailments and diabetes mellitus have also been implicated in severe disease outcomes. It has been found that a dysregulation of the renin-angiotensin system (RAS) plays a key role in the initiation of lung damage after SARS-CoV-2 infection, and RAS inhibitors may reestablish the equilibrium between the “classic RAS” arm and its counter regulatory arm, here defined as “anti-RAS,” of which ACE2 is the keystone. Till now, there has been paucity of solid evidence to either recommend or discontinue usage of ACEI/ARB medications in hypertensive patients in the midst of menace posed by COVID-19. Hence, we tried to summarize and simplify the myths and facts known so far regarding the subject matter to find out a possibilities and feasibilities regarding the use of ACEI/ARB in hypertensives patients who have also contracted COVID-19 and the their role in influencing progression of the disease to severe forms or death.

Keywords: Angiotensin-Converting Enzyme Inhibitors; Hypertension; Angiotensin Receptor Blockers; Covid-19

References

  1. Al-Baadani AM., et al. “Characteristics and outcome of viral pneumonia caused by influenza and Middle East respiratory syndrome-coronavirus infections: a 4-year experience from a tertiary care center”. Annals of Thoracic Medicine 14 (2019): 179-185.
  2. Amat-Santos IJ., et al. “Ramipril in high risk patients with COVID-19”. Journal of the American College of Cardiology 76 (2020): 268-276.
  3. De Abajo FJ., et al. “MED-ACE2-COVID19 study group. Use of renin-angiotensin-aldosterone system inhibitors and risk of COVID-19 requiring admission to hospital: a case-population study”. Lancet 395 (2020): 1705-1714.
  4. De Maria ML., et al. “Anti-hypertensive effects of diminazene aceturate: an angiotensin- converting enzyme 2 activator in rats”. Protein and Peptide Letters 23 (2016): 9-16.
  5. Fang L., et al. “Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?” The Lancet Respiratory Medicine 8 (2020): e21.
  6. Pan F., et al. “Time course of lung changes on chest CT during recovery from 2019 novel coronavirus (COVID-19) pneumonia”. Radiology 295 (2020): 715-721.
  7. Paz Ocaranza M., et al. “Counter-regulatory renin-angiotensin system in cardiovascular disease”. Nature Reviews Cardiology 17 (2020): 116-129.
  8. Sarzani R., et al. “Severe acute respiratory syndrome coronavirus 2 infection, angiotensin-converting enzyme 2 and treatment with angiotensin-converting enzyme inhibitors or angiotensin II type 1 receptor blockers”. European Journal of Preventive Cardiology (2020).
  9. Wiener RS., et al. “Angiotensin converting enzyme 2 is primarily epithelial and is developmentally regulated in the mouse lung”. Journal of Cellular Biochemistry 101 (2007): 1278-1291.
  10. Kuba K., et al. “A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus-induced lung injury”. Nature Medicine 11 (2005): 875-879.
  11. Uhal BD., et al. “Angiotensin signalling in pulmonary fibrosis”. The International Journal of Biochemistry and Cell Biology 44 (2012): 465-468.
  12. Shen L., et al. “Losartan prevents sepsis-induced acute lung injury and decreases activation of nuclear factor kappaB and mitogen-activated protein kinases”. Shock 31 (2009): 500-506.
  13. Fosbøl EL., et al. “Association of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use with COVID-19 diagnosis and mortality”. The Journal of the American Medical Association 324 (2020): 168-177.
  14. Mancia G., et al. “Renin-angiotensin-aldosterone system blockers and the risk of Covid-19”. The New England Journal of Medicine 382 (2020): 2431-2440.
  15. Mehta N., et al. “Association of use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers with testing positive for coronavirus disease 2019 (COVID-19)”. The Journal of the American Medical Association Cardiology (2020).
  16. Reynolds HR., et al. “Renin-angiotensin-aldosterone system inhibitors and risk of Covid-19”. The New England Journal of Medicine 382 (2020): 2441-2448.
  17. Guo X., et al. “Decreased mortality of COVID-19 with renin-angiotensin-aldosterone system inhibitors therapy in patients with hypertension: a meta-analysis”. Hypertension 76 (2020): e13-e14.
  18. Jung SY., et al. “Association of renin-angiotensin-aldosterone system inhibitors with COVID-19-related outcomes in Korea: a nationwide population-based cohort study”. Clinical Infectious Diseases (2020).
  19. Li J., et al. “Association of renin-angiotensin system inhibitors with severity or risk of death in patients with hypertension hospitalized for coronavirus disease 2019 (COVID-19) infection in Wuhan, China”. JAMA Cardiology 5 (2020): 1-6.
  20. Zhang P., et al. “Association of inpatient use of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers with mortality among patients with hypertension hospitalized with COVID-19”. Circulation Research 126 (2020): 1671-1681.
  21. Spannella F., et al. “Renin-angiotensin system blockers and statins are associated with lower in-hospital mortality in very elderly hypertensives”. Journal of the American Medical Directors Association 19 (2018): 342-347.
  22. Sattar N., et al. “Obesity is a risk factor for severe COVID-19 infection: multiple potential mechanisms”. Circulation 142 (2020): 4-6.
  23. Lighter J., et al. “Obesity in patients younger than 60 years is a risk factor for Covid-19 hospital admission”. Clinical Infectious Diseases (2020).
  24. Simonnet A., et al. “LICORN and the Lille COVID-19 and Obesity study group . High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation”. Obesity 28 (2020): 1195-1199.
  25. Sarzani R., et al. “Hypertensive heart disease and obesity: a complex interaction between hemodynamic and not hemodynamic factors”. High Blood Pressure and Cardiovascular Prevention 21 (2014): 81-87.
  26. Spannella F., et al. “Prevalence and control of dyslipidemia in patients referred for high blood pressure: the disregarded “double-trouble” lipid profile in overweight/obese”. Advances in Therapy 36 (2019): 1426-1437.
  27. Santos RAS., et al. “The renin-angiotensin system: going beyond the classical paradigms”. The American Journal of Physiology: Heart and Circulatory Physiology 316 (2019): H958-H970.
  28. Massiéra F., et al. “Adipose angiotensinogen is involved in adipose tissue growth and blood pressure regulation”. The FASEB Journal 15 (2001): 2727-2729.
  29. Sarzani R., et al. “Renin-angiotensin system, natriuretic peptides, obesity, metabolic syndrome, and hypertension: an integrated view in humans”. Journal of Hypertension 26 (2008): 831-843.
  30. Mo P., et al. “Clinical characteristics of refractory COVID-19 pneumonia in Wuhan, China”. Clinical Infectious Diseases (2020).
  31. Grasselli G., et al. “NCOVID-19 Lombardy ICU Network . Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy”. The Journal of the American Medical Association 323 (2020): 1574-1581.
  32. White MC., et al. “Sex differences in the metabolic effects of the renin-angiotensin system”. Biology of Sex Differences 10 (2019): 31.
  33. Lukassen S., et al. “SARS-CoV-2 receptor ACE2 and TMPRSS2 are primarily expressed in bronchial transient secretory cells”. The EMBO Journal 39 (2020): e105114.
  34. Onder G., et al. “Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy”. The Journal of the American Medical Association 323 (2020): 1775-1776.
  35. Zambelli V., et al. “Angiotensin-(1-7) improves oxygenation, while reducing cellular infiltrate and fibrosis in experimental acute respiratory distress syndrome”. Intensive Care Medicine Experimental 3 (2015): 8.
  36. Zheng YY., et al. “COVID-19 and the cardiovascular system”. Nature Reviews Cardiology 17 (2020): 259-260.
Citation: Nadeem Iqbal., et al. “Use of Renin-Angiotensin System Inhibitors in Hypertensive Patients in COVID-19 Era: A Review”.EC Clinical and Medical Case Reports 3.11 (2020): 01-06.

PubMed Indexed Article


EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events


April Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the April issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for upcoming Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before April 26, 2021.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to editor@ecronicon.uk