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. 2020 Dec;9(1):757-760.
doi: 10.1080/22221751.2020.1746200.

Renin-angiotensin system inhibitors improve the clinical outcomes of COVID-19 patients with hypertension

Juan Meng  1   2 , Guohui Xiao  1   2 , Juanjuan Zhang  1 , Xing He  1 , Min Ou  1 , Jing Bi  1 , Rongqing Yang  1 , Wencheng Di  1 , Zhaoqin Wang  1 , Zigang Li  2 , Hong Gao  1 , Lei Liu  1 , Guoliang Zhang  1   2   3
Affiliations

Renin-angiotensin system inhibitors improve the clinical outcomes of COVID-19 patients with hypertension

Juan Meng et al. Emerg Microbes Infect. 2020 Dec.

Abstract

The dysfunction of the renin-angiotensin system (RAS) has been observed in coronavirus infection disease (COVID-19) patients, but whether RAS inhibitors, such as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II type 1 receptor blockers (ARBs), are associated with clinical outcomes remains unknown. COVID-19 patients with hypertension were enrolled to evaluate the effect of RAS inhibitors. We observed that patients receiving ACEI or ARB therapy had a lower rate of severe diseases and a trend toward a lower level of IL-6 in peripheral blood. In addition, ACEI or ARB therapy increased CD3 and CD8 T cell counts in peripheral blood and decreased the peak viral load compared to other antihypertensive drugs. This evidence supports the benefit of using ACEIs or ARBs to potentially contribute to the improvement of clinical outcomes of COVID-19 patients with hypertension.

Keywords: COVID-19; Renin-angiotensin system; angiotensin II type1 receptor blockers; angiotensin-converting enzyme inhibitors; hypertension.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Summarized clinical, inflammatory, immunological, and viral findings in the non-ACEI/ARB group and the ACE/ARB group. (A) The disease severity distribution of the two groups during hospitalization. (B) The levels of IL-6 and CRP in peripheral blood. (C) Absolute numbers of CD3+, CD4+, and CD8+ T cells in peripheral blood. (D) Viral load on hospital admission and maximum value during hospitalization. The data are expressed as the median and IQR. An unpaired t test was used, and P < 0.05 was considered significant.
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Grants and funding

This work was supported by the National Natural Science Foundation of China (No. 81873958), the China Postdoctoral Science Foundation (No. 2019M653108), the National Science and Technology Major Project for Control and Prevention of Major Infectious Diseases of China (No. 2017ZX10103004), the State Key Laboratory of Respiratory Diseases Open Project (No. SKLRD-OP-201919), and the Sanming Project of Medicine in Shenzhen (No. SZSM201911009).