Uso previo de antagonistas de la angiotensina II en pacientes hipertensos hospitalizados y mortalidad por COVID-19

Teodoro J. Oscanoa; Jose  Amado-Tineo; Javier  Matta-Pérez; Waldo  Taype-Huamaní

doi:10.35434/rcmhnaaa.2022.153.1335

Authors

Teodoro J. Oscanoa Universidad de San Martin de Porres, Facultad de Medicina Humana. Centro de Investigación de Seguridad del Medicamento, Lima Perú; Universidad Nacional Mayor de San Marcos, Facultad de Medicina. Lima Perú ; Hospital Nacional Guillermo Almenara, EsSalud, Lima, Perú.
Jose Amado-Tineo Universidad Nacional Mayor de San Marcos, Facultad de Medicina. Lima Perú; Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima Perú.
Javier Matta-Pérez Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima Perú.
Waldo Taype-Huamaní Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima Perú.

DOI:

https://doi.org/10.35434/rcmhnaaa.2022.153.1335

Keywords:

COVID-19, SARS-COV-2, Angiotensin Receptor Antagonists, mortality, Hypertension

Abstract

Introduction: There is currently great interest in establishing the relationship between the severity of SARSCOV-2 infection in hypertensive patients who use angiotensin II antagonists (AIIRAs). Objective: To study the relationship between the previous use of angiotensin II antagonists (ARB) in hypertensive patients and mortality from COVID-19. Materials and methods: A retrospective observational study was carried out in a tertiary care hospital in Lima, Peru, in hypertensive patients hospitalized in March 2021 for severe COVID-19. Results: A total of 101 patients entered the study, with a mean age of 70.1 + 12.0 and 48% male. ARB users and non-users were 45 (45.6%) and 56 (54.4%), respectively. The Charlson Comorbidity Index was higher in the ARB group (3.6 + 1.56 vs 3.04 + 1.24) (p<0.05). Total and male vs women mortality, among those using ARBs or not, were 57.8% vs 62% (p = 0.633) and 36.36% vs 63.64% (p <0.05), respectively. Mean lactate dehydrogenase concentration was lower in those taking ARBs compared to non-users, 394.18 + 152.3 vs 503.5 + 252.7 (p<0.05); No significant difference was observed in the leukocyte count and serum levels of C-Reactive Protein, Ferritin, D-dimer and fibrinogen. Conclusion: Among hospitalized COVID-19 patients with hypertension, prior use of ARBSs was not associated with mortality risk.

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Author Biographies

Teodoro J. Oscanoa, Universidad de San Martin de Porres, Facultad de Medicina Humana. Centro de Investigación de Seguridad del Medicamento, Lima Perú; Universidad Nacional Mayor de San Marcos, Facultad de Medicina. Lima Perú ; Hospital Nacional Guillermo Almenara, EsSalud, Lima, Perú.

Doctor en Medicina

Jose Amado-Tineo , Universidad Nacional Mayor de San Marcos, Facultad de Medicina. Lima Perú; Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima Perú.

Doctor en Medicina

Javier Matta-Pérez, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima Perú.

1. Médico internista

Waldo Taype-Huamaní, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima Perú.

1. Médico especialista en Medicina de Emergencias y Desastres

References

Eckenstaler R, Sandori J, Gekle M, Benndorf RA. Angiotensin II receptor type 1 – An update on structure, expression and pathology. Biochem Pharmacol [Internet]. 2021 Oct;192:114673. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0006295221002860

Zimlichman R. Differential clinical profile of candesartan compared to other angiotensin receptor blockers. Vasc Health Risk Manag [Internet]. 2011 Dec;749. Available from: http://www.dovepress.com/differential-clinical-profile-of-candesartan-compared-to-other-angiote-peer-reviewed-article-VHRM

Hill RD, Vaidya PN. Angiotensin II Receptor Blockers (ARB) [Internet]. StatPearls. 2022. Available from: http://www.ncbi.nlm.nih.gov/pubmed/30725712

Sommerstein R, Kochen MM, Messerli FH, Gräni C. Coronavirus Disease 2019 (COVID‐19): Do Angiotensin‐Converting Enzyme Inhibitors/Angiotensin Receptor Blockers Have a Biphasic Effect? J Am Heart Assoc [Internet]. 2020 Apr 9;9(7). Available from: https://www.ahajournals.org/doi/10.1161/JAHA.120.016509

Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med [Internet]. 2020 Apr;8(4):e21. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2213260020301168

Ferrario CM, Jessup J, Chappell MC, Averill DB, Brosnihan KB, Tallant EA, et al. Effect of Angiotensin-Converting Enzyme Inhibition and Angiotensin II Receptor Blockers on Cardiac Angiotensin-Converting Enzyme 2. Circulation [Internet]. 2005 May 24;111(20):2605–10. Available from: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.104.510461

Oscanoa TJ, Vidal X, Carvajal A, Amado J, Romero-Ortuno R. Severity of SARS-COV-2 infection and angiotensin converting enzyme inhibitors and angiotensin receptor blockers: a meta-analysis. Arter Hypertens [Internet]. 2020 Sep 29;24(3):106–14. Available from: https://journals.viamedica.pl/arterial_hypertension/article/view/70334

Wang Y, Chen B, Li Y, Zhang L, Wang Y, Yang S, et al. The use of renin–angiotensin–aldosterone system (RAAS) inhibitors is associated with a lower risk of mortality in hypertensive COVID‐19 patients: A systematic review and meta‐analysis. J Med Virol [Internet]. 2021 Mar 10;93(3):1370–7. Available from: https://onlinelibrary.wiley.com/doi/10.1002/jmv.26625

Lee HW, Yoon C-H, Jang EJ, Lee C-H. Renin-angiotensin system blocker and outcomes of COVID-19: a systematic review and meta-analysis. Thorax [Internet]. 2021 May;76(5):479–86. Available from: https://thorax.bmj.com/lookup/doi/10.1136/thoraxjnl-2020-215322

Lee T, Cau A, Cheng MP, Levin A, Lee TC, Vinh DC, et al. Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors in COVID-19: Meta-analysis/Meta-regression Adjusted for Confounding Factors. CJC Open [Internet]. 2021 Jul;3(7):965–75. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2589790X21000718

Li K, Fang Y, Li W, Pan C, Qin P, Zhong Y, et al. CT image visual quantitative evaluation and clinical classification of coronavirus disease (COVID-19). Eur Radiol [Internet]. 2020 Aug 25;30(8):4407–16. Available from: http://link.springer.com/10.1007/s00330-020-06817-6

Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol [Internet]. 1994 Nov;47(11):1245–51. Available from: https://linkinghub.elsevier.com/retrieve/pii/0895435694901295

Pranata R, Permana H, Huang I, Lim MA, Soetedjo NNM, Supriyadi R, et al. The use of renin angiotensin system inhibitor on mortality in patients with coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. Diabetes Metab Syndr Clin Res Rev [Internet]. 2020 Sep;14(5):983–90. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1871402120302162

Chu C, Zeng S, Hasan AA, Hocher C, Krämer BK, Hocher B. Comparison of infection risks and clinical outcomes in patients with and without SARS‐CoV‐2 lung infection under renin–angiotensin–aldosterone system blockade: Systematic review and meta‐analysis. Br J Clin Pharmacol [Internet]. 2021 Jun 18;87(6):2475–92. Available from: https://onlinelibrary.wiley.com/doi/10.1111/bcp.14660

Patoulias D, Katsimardou A, Stavropoulos K, Imprialos K, Kalogirou M-S, Doumas M. Renin-Angiotensin System Inhibitors and COVID-19: a Systematic Review and Meta-Analysis. Evidence for Significant Geographical Disparities. Curr Hypertens Rep [Internet]. 2020 Nov 10;22(11):90. Available from: https://link.springer.com/10.1007/s11906-020-01101-w

Bezabih YM, Bezabih A, Alamneh E, Peterson GM, Bezabhe W. Comparison of renin–angiotensin–aldosterone system inhibitors with other antihypertensives in association with coronavirus disease-19 clinical outcomes. BMC Infect Dis [Internet]. 2021 Dec 5;21(1):527. Available from: https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06088-6

Bavishi C, Whelton PK, Mancia G, Corrao G, Messerli FH. Renin–angiotensin-system inhibitors and all-cause mortality in patients with COVID-19: a systematic review and meta-analysis of observational studies. J Hypertens [Internet]. 2021 Apr;39(4):784–94. Available from: https://journals.lww.com/10.1097/HJH.0000000000002784

Graham DJ, Izurieta HS, Muthuri SG, Zhang D, Sandhu AT, Lu Y, et al. Risk of Covid-19-Related Hospitalization and More Severe Outcomes in Medicare Beneficiaries Treated with Renin-Angiotensin-Aldosterone System Inhibitors for Hypertension. J Gen Intern Med [Internet]. 2021 Dec 1;36(12):3802–9. Available from: https://link.springer.com/10.1007/s11606-021-07155-z

Rizk JG, Wenziger C, Tran D, Hashemi L, Moradi H, Streja E, et al. Angiotensin-Converting Enzyme Inhibitor and Angiotensin Receptor Blocker Use Associated with Reduced Mortality and Other Disease Outcomes in US Veterans with COVID-19. Drugs [Internet]. 2022 Jan 16;82(1):43–54. Available from: https://link.springer.com/10.1007/s40265-021-01639-2

Gori M, Berzuini C, D’Elia E, Ghirardi A, Bernardinelli L, Gavazzi A, et al. Antecedent use of renin-angiotensin system inhibitors is associated with reduced mortality in elderly hypertensive Covid-19 patients. J Hypertens [Internet]. 2021 Dec 9;Publish Ah. Available from: https://journals.lww.com/10.1097/HJH.0000000000003059

Ma Y, Zhang Y, Li S, Yang H, Li H, Cao Z, et al. Sex Differences in Association Between Anti-Hypertensive Medications and Risk of COVID-19 in Middle-Aged and Older Adults. Drugs Aging [Internet]. 2021 Oct 18;38(10):921–30. Available from: https://link.springer.com/10.1007/s40266-021-00886-y

Blum S, Lampart M, Zhou Q, Mueller C, Osswald S, Kuster GM, et al. Antihypertensive medication and outcome in patients with COVID-19 compared to non-COVID respiratory infections. Eur Heart J [Internet]. 2021 Oct 12;42(Supplement_1). Available from: https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehab724.2395/6392920

Safizadeh F, Nguyen TNM, Brenner H, Schöttker B. Association of Renin–Angiotensin–Aldosterone System inhibition with Covid‐19 hospitalization and all‐cause mortality in the UK Biobank. Br J Clin Pharmacol [Internet]. 2021 Dec 22; Available from: https://onlinelibrary.wiley.com/doi/10.1111/bcp.15192

Kuzeytemiz M, Tenekecioglu E. Effect of renin-angiotensin system blocker on COVID-19 in young patients with hypertension. J Investig Med [Internet]. 2022 Jan 5;jim-2021-002036. Available from: https://jim.bmj.com/lookup/doi/10.1136/jim-2021-002036

Rocheleau G, Lee T, Mohammed Y, Goodlet D, Burns K, Cheng M, et al. 22: ARBS AND ACE INHIBITORS ARE ASSOCIATED WITH IMPROVED OUTCOMES IN MALES HOSPITALIZED WITH COVID-19. Crit Care Med [Internet]. 2022 Jan 16;50(1):11–11. Available from: https://journals.lww.com/10.1097/01.ccm.0000806556.31179.02

Mancia G, Rea F, Ludergnani M, Apolone G, Corrao G. Renin–Angiotensin–Aldosterone System Blockers and the Risk of Covid-19. N Engl J Med [Internet]. 2020 Jun 18;382(25):2431–40. Available from: http://www.nejm.org/doi/10.1056/NEJMoa2006923

Duarte M, Pelorosso F, Nicolosi LN, Victoria Salgado M, Vetulli H, Aquieri A, et al. Telmisartan for treatment of Covid-19 patients: An open multicenter randomized clinical trial. EClinicalMedicine [Internet]. 2021 Jul;37:100962. Available from: https://linkinghub.elsevier.com/retrieve/pii/S258953702100242X

Chen D, Li X, Song Q, Hu C, Su F, Dai J, et al. Assessment of Hypokalemia and Clinical Characteristics in Patients With Coronavirus Disease 2019 in Wenzhou, China. JAMA Netw Open [Internet]. 2020 Jun 11;3(6):e2011122. Available from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767008

Zhao H, Li Y, Wang D, Yuan H. ARB might be superior to ACEI for treatment of hypertensive COVID‐19 patients. J Cell Mol Med [Internet]. 2021 Dec 11;25(23):11031–4. Available from: https://onlinelibrary.wiley.com/doi/10.1111/jcmm.17051

Nejat R, Sadr AS, Freitas B, Crabttree J, Pegan SD, Tripp RA, et al. Losartan Inhibits SARS-CoV-2 Replication in Vitro. J Pharm Pharm Sci [Internet]. 2021 Jul 27;24:390–9. Available from: https://journals.library.ualberta.ca/jpps/index.php/JPPS/article/view/31931

Oscanoa TJ, Amado J, Vidal X, Savarino A, Romero-Ortuno R. Metformin therapy and severity and mortality of SARS-CoV-2 infection: a meta-analysis. Clin Diabetol [Internet]. 2021 May 24; Available from: https://journals.viamedica.pl/clinical_diabetology/article/view/75056