Volume 3, Issue 1 (Winter 2022)                   J Vessel Circ 2022, 3(1): 35-42 | Back to browse issues page


XML Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Karimi Matloub R, Ghadimi H R, Karimi Matloub S, Khodadadi J, Tafaroji J, Khani S. Inhibition of Renin-angiotensin System and Clinical Outcomes of COVID-19. J Vessel Circ 2022; 3 (1) :35-42
URL: http://jvessels.muq.ac.ir/article-1-214-en.html
1- Student Research Committee, Arak University of Medical Sciences, Arak, Iran, Arak University of Medical Sciences, Arak, Iran, ORCID ID: 0000-0002-3501-2912
2- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran., Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran, ORCID ID:0000-0003-3226-9963
3- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran, Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran, ORCID ID: 0000-0002-0258-3137
4- Department of Infectious Diseases, Faculty of Medicine, Qom University of Medical Sciences, Qom, Iran., Department of Infectious Diseases, Faculty of Medicine, Qom University of Medical Sciences, Qom, Iran. ORCID ID: 0000-0002-2777-5709
5- Department of Infectious Diseases, Faculty of Medicine, Qom University of Medical Sciences, Qom, Iran., Pediatric Medicine Research Center, Qom University of Medical Sciences, Qom, Iran. ORCID ID: 0000-0003-0598-9949
6- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran, Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran, (Corresponding Author), Tel: +98-25-31971033, Fax: +98-25-33209127, Email: : pharma_75@yahoo.com. ORCID ID: 0000-0001-5981-8358
Abstract:   (936 Views)
Background and Aim: COVID-19 is an acute respiratory illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A few studies with conflicting results have been performed to evaluate the relationship between the use of angiotensin system inhibitors and COVID-19 outcomes. Therefore, this study was performed to compare the clinical and paraclinical characteristics of patients with COVID-19 in two groups of patients treated with angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) and the control group (no history of ACEIs/ARBs) in Kamkar and Shahid Beheshti hospitals in Qom City, Iran from March 14, 2019, to the end of September 21, 2020.
Materials and Methods: This retrospective descriptive study was performed by reviewing the medical record of 359 patients with COVID-19, which was confirmed by a physician via lung scan or reverse transcription polymerase chain reaction (RT-PCR). We used the independent t test to compare quantitative variables and the Chi-square test to analyze qualitative variables.
Results: The common clinical symptoms, number of hospitalization days, oxygen saturation, and lung involvement were not significantly different between the two groups. Weakness, nausea, and sweating were significantly reduced in the control group compared to the ACEIs/ARBs group (P<0.05). Regarding the biochemical study, the patients’ hemoglobin levels and lymphocyte count on the first day of hospitalization in the ACEIs/ARBs group were significantly lower than the control (P<0.05)
Conclusion: These findings do not provide evidence of adverse or beneficial effects of angiotensin system inhibitors, so we require more detailed studies with a larger sample size.
Full-Text [PDF 831 kb]   (239 Downloads) |   |   Full-Text (HTML)  (205 Views)  
Type of Study: Research | Subject: vascular pharmacology
Received: 2022/04/6 | Accepted: 2022/05/1 | Published: 2022/07/1

References
1. Clerkin KJ, Fried JA, Raikhelkar J, Sayer G, Griffin JM, Masoumi A, et al. Covid-19 and cardiovascular disease. Circulation. 2020; 141(20):1648-55. [DOI:10.1161/CIRCULATIONAHA.120.046941] [PMID] [DOI:10.1161/CIRCULATIONAHA.120.046941]
2. Patel AB, Verma A. Covid-19 and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: What is the evidence? JAMA. 2020; 323(18):1769-70. [DOI:10.1001/jama.2020.4812] [PMID] [DOI:10.1001/jama.2020.4812]
3. Ahmadi A, Fadai Y, Shirani M, Rahmani F. Modeling and forecasting trend of covid-19 epidemic in Iran until May 13, 2020. Med J Islam Repub Iran. 2020; 34(1):183-95. [DOI:10.47176/mjiri.34.27] [PMID] [PMCID] [DOI:10.47176/mjiri.34.27]
4. Ho WS, Zhang R, Tan YL, Chai CLL. Covid-19 and the promise of small molecule therapeutics: Are there lessons to be learnt? Pharmacol Res. 2022; 179:106201. [DOI:10.1016/j.phrs.2022.106201] [PMID] [PMCID] [DOI:10.1016/j.phrs.2022.106201]
5. Hughes DL. Quest for a cure: Potential small-molecule treatments for covid-19, Part 2. Org Process Res Dev. 2021; 25(5): 1089-111. [DOI:10.1021/acs.oprd.1c00100] [PMCID] [DOI:10.1021/acs.oprd.1c00100]
6. Bavishi C, Maddox TM, Messerli FH. Coronavirus disease 2019 (covid-19) infection and renin angiotensin system blockers. JAMA Cardiol. 2020; 5(7):745-7. [DOI:10.1001/jamacardio.2020.1282] [PMID] [DOI:10.1001/jamacardio.2020.1282]
7. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (covid-19) outbreak in China: Summary of a report of 72314 cases from the Chinese center for disease control and prevention. JAMA. 2020; 323(13):1239-42. [DOI:10.1001/jama.2020.2648] [PMID] [DOI:10.1001/jama.2020.2648]
8. Sparks MA, Crowley SD, Gurley SB, Mirotsou M, Coffman TM. Classical renin‐angiotensin system in kidney physiology. Compr Physiol. 2011; 4(3):1201-28. [DOI:10.1002/cphy.c130040] [PMID] [PMCID] [DOI:10.1002/cphy.c130040]
9. Vaduganathan M, Vardeny O, Michel T, McMurray JJ, Pfeffer MA, Solomon SD. Renin-angiotensin-aldosterone system inhibitors in patients with covid-19. N Engl J Med. 2020; 382(17):1653-9. [DOI:10.1056/NEJMsr2005760] [PMID] [PMCID] [DOI:10.1056/NEJMsr2005760]
10. Peiró C, Moncada S. Substituting angiotensin-(1-7) to prevent lung damage in SARSCoV2 infection? Circulation. 2020; 141(21):1665-6. [DOI:10.1161/CIRCULATIONAHA.120.047297] [PMID] [PMCID] [DOI:10.1161/CIRCULATIONAHA.120.047297]
11. Wu Y. Compensation of ACE2 function for possible clinical management of 2019-nCoV-induced acute lung injury. Virol Sin. 2020; 35(3):256-8. [DOI:10.1007/s12250-020-00205-6] [PMID] [PMCID] [DOI:10.1007/s12250-020-00205-6]
12. Donoghue M, Hsieh F, Baronas E, Godbout K, Gosselin M, Stagliano N, et al. A novel angiotensin-converting enzyme-related carboxypeptidase (ACE2) converts angiotensin I to angiotensin 1-9. Circulation Res. 2000; 87(5):e1-9. [DOI:10.1161/01.RES.87.5.e1] [PMID] [DOI:10.1161/01.RES.87.5.e1]
13. Imai Y, Kuba K, Ohto-Nakanishi T, Penninger JM. Angiotensin-converting enzyme 2 (ACE2) in disease pathogenesis. Circ J. 2010; 74(3):405-10. [DOI:10.1253/circj.CJ-10-0045] [PMID] [DOI:10.1253/circj.CJ-10-0045]
14. Van De Veerdonk F, Netea MG, Van Deuren M, Van Der Meer JW, De Mast Q, Bruggemann RJ, et al. Kinins and cytokines in covid-19: A comprehensive pathophysiological approach. 2020. [Unpublished article]. [DOI:10.20944/preprints202004.0023.v1] [DOI:10.20944/preprints202004.0023.v1]
15. Zhang H, Penninger JM, Li Y, Zhong N, Slutsky AS. Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: Molecular mechanisms and potential therapeutic target. Intensive Care Med. 2020; 6(4):586-50. [DOI:10.1007/s00134-020-05985-9] [PMID] [PMCID] [DOI:10.1007/s00134-020-05985-9]
16. Walls AC, Park YJ, Tortorici MA, Wall A, McGuire AT, Veesler D. Structure, function, and antigenicity of the SARS-CoV-2 spike glycoprotein. Cell. 2020; 181(2):281-92.e6. [DOI:10.1016/j.cell.2020.02.058] [PMID] [PMCID] [DOI:10.1016/j.cell.2020.02.058]
17. Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020; 181(2):271-80.e8. [DOI:10.1016/j.cell.2020.02.052] [PMID] [PMCID] [DOI:10.1016/j.cell.2020.02.052]
18. Cook JR, Ausiello J. Functional ACE2 deficiency leading to angiotensin imbalance in the pathophysiology of covid-19. Rev Endocr Metab Disord. 2022; 23(2):151-70. [DOI:10.1007/s11154-021-09663-z] [PMID] [PMCID] [DOI:10.1007/s11154-021-09663-z]
19. Flack JM, Adekola B. Blood pressure and the new ACC/AHA hypertension guidelines. Trends Cardiovasc Med. 2020; 30(3):160-4. [DOI:10.1016/j.tcm.2019.05.003] [PMID] [DOI:10.1016/j.tcm.2019.05.003]
20. Kovell LC, Ahmed HM, Misra S, Whelton SP, Prokopowicz GP, Blumenthal RS, et al. US hypertension management guidelines: A review of the recent past and recommendations for the future. J Am Heart Assoc. 2015; 4(12):e002315. [DOI:10.1161/JAHA.115.002315] [PMID] [PMCID] [DOI:10.1161/JAHA.115.002315]
21. 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. 2020; 9(7):e016509. [DOI:10.1161/JAHA.120.016509] [PMID] [PMCID] [DOI:10.1161/JAHA.120.016509]
22. Li J, Wang X, Chen J, Zhang H, Deng A. 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 Cardiol. 2020; 5(7):1-6. [DOI:10.1001/jamacardio.2020.1624] [PMID] [PMCID] [DOI:10.1001/jamacardio.2020.1624]
23. Zhang P, Zhu L, Cai J, Lei F, Qin JJ, Xie J, 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. Circ Res. 2020; 126(12):1671-81. [DOI:10.1161/CIRCRESAHA.120.317242] [PMID] [PMCID] [DOI:10.1161/CIRCRESAHA.120.317242]
24. Gurwitz D. Angiotensin receptor blockers as tentative SARS‐CoV‐2 therapeutics. Drug Dev Res. 2020; 81(5):537-40.[DOI:10.1002/ddr.21656] [PMID] [PMCID] [DOI:10.1002/ddr.21656]
25. Mehta N, Kalra A, Nowacki AS, Anjewierden S, Han Z, Bhat P, et al. Association of use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers with testing positive for coronavirus disease 2019 (covid-19). JAMA Cardiol. 2020; e201855. [DOI:10.1001/jamacardio.2020.1855] [PMID] [PMCID] [DOI:10.1001/jamacardio.2020.1855]
26. Chen L, Li X, Chen M, Feng Y, Xiong C. The ACE2 expression in human heart indicates new potential mechanism of heart injury among patients infected with SARS-CoV-2. Cardiovasc Res. 2020; 116(6):1097-100. [DOI:10.1093/cvr/cvaa078] [PMID] [PMCID] [DOI:10.1093/cvr/cvaa078]
27. Sun ML, Yang JM, Sun YP, Su GH. [Inhibitors of RAS might be a good choice for the therapy of covid-19 pneumonia (Chinese)]. Zhonghua Jie He He Hu Xi Za Zhi. 2020; 43(3):219-22. [DOI:10.3760/cma.j.issn.1001-0939.2020.03.016] [PMID]
28. Lopes RD, Macedo AVS, de Barros E Silva PGM, Moll-Bernardes RJ, Dos Santos TM, Mazza L, et al. Effect of discontinuing vs continuing angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on days alive and out of the hospital in patients admitted with covid-19: A randomized clinical trial. JAMA. 2021; 325(3):254-64. [DOI: 10.1001/jama.2020.25864] [PMID] [PMCID] [DOI:10.1001/jama.2020.25864]
29. Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for covid-19 infection? Lancet Respir Med. 2020; 8(4):e21. [DOI:10.1016/S2213-2600(20)30116-8] [PMID] [DOI:10.1016/S2213-2600(20)30116-8]
30. Gnavi R, Demaria M, Picariello R, Dalmasso M, Ricceri F, Costa G. Therapy with agents acting on the renin-angiotensin system and risk of severe acute respiratory syndrome coronavirus 2 infection. Clin Infect Dis. 2020; 71(16):2291-3. [DOI:10.1093/cid/ciaa634] [PMID] [PMCID] [DOI:10.1093/cid/ciaa634]
31. 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. 2020; 382(25):2431-40. [DOI:10.1056/NEJMoa2006923] [PMID] [PMCID] [DOI:10.1056/NEJMoa2006923]
32. Reynolds HR, Adhikari S, Pulgarin C, Troxel AB, Iturrate E, Johnson SB, et al. Renin-angiotensin-aldosterone system inhibitors and risk of covid-19. N Engl J Med. 2020; 382(25):2441-8. [DOI:10.1056/NEJMoa2008975] [PMID] [PMCID] [DOI:10.1056/NEJMoa2008975]
33. de Abajo FJ, Rodríguez-Martín S, Lerma V, Mejía-Abril G, Aguilar M, García-Luque A, et al. Use of renin-angiotensin-aldosterone system inhibitors and risk of covid-19 requiring admission to hospital: A case-population study. Lancet. 2020; 395(10238):1705-14. [DOI:10.1016/S0140-6736(20)31030-8] [PMID] [DOI:10.1016/S0140-6736(20)31030-8]
34. Lee MM, Docherty KF, Sattar N, Mehta N, Kalra A, Nowacki AS, et al. Renin-angiotensin system blockers, risk of SARS-CoV-2 infection and outcomes from covid-19: Systematic review and meta-analysis. Eur Heart J Cardiovasc Pharmacother. 2022; 8(2):165-78. [DOI:10.1093/ehjcvp/pvaa138] [PMID] [PMCID] [DOI:10.1093/ehjcvp/pvaa138]
35. 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. 2022; 82(1):43-54. [DOI:10.1007/s40265-021-01639-2] [PMID] [PMCID] [DOI:10.1007/s40265-021-01639-2]
36. Hippisley-Cox J, Young D, Coupland C, Channon KM, San Tan P, Harrison DA, et al. Risk of severe covid-19 disease with ACE inhibitors and angiotensin receptor blockers: Cohort study including 8.3 million people. Heart. 2020; 106(19):1503-11. [DOI:10.1136/heartjnl-2020-317393] [PMID] [PMCID] [DOI:10.1136/heartjnl-2020-317393]

Add your comments about this article : Your username or Email:
CAPTCHA

Send email to the article author


Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2025 CC BY-NC 4.0 | Journal of Vessels and Circulation

Designed & Developed by : Yektaweb