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Publication
Angiotensin-Converting Enzyme Inhibitors, Angiotensin II Receptor Blockers, and
Outcomes in Patients Hospitalized for COVID-19.
Authors Pan M, Vasbinder A, Anderson E, Catalan T, Shadid HR, Berlin H, Padalia K,
O'Hayer P, Meloche C, Azam TU, Khaleel I, Michaud E, Blakely P, Bitar A, Huang
Y, Zhao L, Pop-Busui R, Loosen SH, Chalkias A, Tacke F, Giamarellos-Bourboulis
EJ, Reiser J, Eugen-Olsen J, Hayek SS,
Submitted By Submitted Externally on 1/10/2022
Status Published
Journal Journal of the American Heart Association
Year 2021
Date Published 12/1/2021
Volume : Pages 10 : e023535
PubMed Reference 34889102
Abstract Background Use of angiotensin-converting enzyme inhibitors and angiotensin
receptor blockers (ACEi/ARB) is thought to affect COVID-19 through modulating
levels of angiotensin-converting enzyme 2, the cell entry receptor for
SARS-CoV2. We sought to assess the association between ACEi/ARB, biomarkers of
inflammation, and outcomes in patients hospitalized for COVID-19. Methods and
Results We leveraged the ISIC (International Study of Inflammation in COVID-19),
identified patients admitted for symptomatic COVID-19 between February 1, 2020
and June 1, 2021 for COVID-19, and examined the association between in-hospital
ACEi/ARB use and all-cause death, need for ventilation, and need for dialysis.
We estimated the causal effect of ACEi/ARB on the composite outcomes using
marginal structural models accounting for serial blood pressure and serum
creatinine measures. Of 2044 patients in ISIC, 1686 patients met inclusion
criteria, of whom 398 (23.6%) patients who were previously on ACEi/ARB received
at least 1 dose during their hospitalization for COVID-19. There were 215
deaths, 407 patients requiring mechanical ventilation, and 124 patients who
required dialysis during their hospitalization. Prior ACEi/ARB use was
associated with lower levels of soluble urokinase plasminogen activator receptor
and C-reactive protein. In multivariable analysis, in-hospital ACEi/ARB use was
associated with a lower risk of the composite outcome of in-hospital death,
mechanical ventilation, or dialysis (adjusted hazard ratio 0.49, 95% CI
[0.36-0.65]). Conclusions In patients hospitalized for COVID-19, ACEi/ARB use
was associated with lower levels of inflammation and lower risk of in-hospital
outcomes. Clinical trials will define the role of ACEi/ARB in the treatment of
COVID-19. Registration URL: https://www.clinicaltrials.gov; Unique identifier:
NCT04818866.




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