Acei and arb
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The Impact of ACEI and ARB on COVID-19: A Comprehensive Review
Introduction to ACEI and ARB in COVID-19 Context
Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are commonly prescribed medications for managing hypertension and other cardiovascular conditions. With the onset of the COVID-19 pandemic, concerns emerged regarding the potential impact of these medications on COVID-19 susceptibility, severity, and mortality due to their influence on ACE2, the receptor for SARS-CoV-2.
ACEI/ARB and COVID-19 Infection Risk
Several studies have investigated whether ACEI/ARB use increases the risk of contracting COVID-19. A systematic review and meta-analysis involving over 19,000 COVID-19 cases found no significant association between ACEI/ARB exposure and the risk of COVID-19 infection (OR = 0.99; 95% CI, 0.95-1.04). Similarly, another comprehensive review concluded that ACEI/ARB use does not increase ACE2 expression in humans, thereby not elevating the risk of COVID-19 infection.
ACEI/ARB and COVID-19 Severity and Mortality
General Population
Multiple studies have consistently shown that ACEI/ARB use does not exacerbate COVID-19 severity or increase mortality. A meta-analysis of 102 studies found no association between prior ACEI/ARB use and severe COVID-19 outcomes or mortality (aOR 0.87, 95% CI 0.66-1.04). Another study confirmed that ACEI/ARB use was not linked to increased severity or mortality in COVID-19 patients (OR 0.73, 95% CI 0.38-1.40).
East-Asian Population
In East-Asian populations, ACEI/ARB use was associated with a shorter hospital stay and lower mortality (OR = 0.61, 95% CI 0.52-0.70) without affecting disease severity. This suggests potential benefits of ACEI/ARB in reducing mortality among COVID-19 patients in this demographic.
Hypertensive Patients
For hypertensive patients hospitalized with COVID-19, ACEI/ARB use was linked to a significantly lower risk of all-cause mortality compared to non-users (adjusted HR 0.42, 95% CI 0.19-0.92). This finding was consistent across various studies, indicating that ACEI/ARB therapy should be continued in hypertensive COVID-19 patients.
Mechanisms and Biological Insights
The biological mechanisms underlying these observations are complex. While ACEIs and ARBs may theoretically increase ACE2 expression, the actual clinical data do not support an increased risk of COVID-19 infection or worse outcomes. In fact, some studies suggest that ARBs, in particular, may offer protective benefits against severe COVID-19 outcomes .
Conclusion
Current evidence overwhelmingly supports the continued use of ACEIs and ARBs in patients with COVID-19. These medications do not increase the risk of infection, severity, or mortality from COVID-19. On the contrary, they may reduce mortality, especially in hypertensive patients. Therefore, discontinuation of ACEI/ARB therapy in the context of COVID-19 is not recommended. Further research may continue to elucidate the nuanced roles these medications play in the context of COVID-19.
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