AUTHOR=Huang Linna , Chen Ziying , Ni Lan , Chen Lei , Zhou Changzhi , Gao Chang , Wu Xiaojing , Hua Lin , Huang Xu , Cui Xiaoyang , Tian Ye , Zhang Zeyu , Zhan Qingyuan 

TITLE=Impact of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on the Inflammatory Response and Viral Clearance in COVID-19 Patients

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.710946

DOI=10.3389/fcvm.2021.710946

ISSN=2297-055X

ABSTRACT=<p><bold>Objectives:</bold> To evaluate the impact of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) on the inflammatory response and viral clearance in coronavirus disease 2019 (COVID-19) patients.</p><p><bold>Methods:</bold> We included 229 patients with confirmed COVID-19 in a multicenter, retrospective cohort study. Propensity score matching at a ratio of 1:3 was introduced to eliminate potential confounders. Patients were assigned to the ACEI/ARB group (<italic>n</italic> = 38) or control group (<italic>n</italic> = 114) according to whether they were current users of medication.</p><p><bold>Results:</bold> Compared to the control group, patients in the ACEI/ARB group had lower levels of plasma IL-1β [(6.20 ± 0.38) vs. (9.30 ± 0.31) pg/ml, <italic>P</italic> = 0.020], IL-6 [(31.86 ± 4.07) vs. (48.47 ± 3.11) pg/ml, <italic>P</italic> = 0.041], IL-8 [(34.66 ± 1.90) vs. (47.93 ± 1.21) pg/ml, <italic>P</italic> = 0.027], and TNF-α [(6.11 ± 0.88) vs. (12.73 ± 0.26) pg/ml, <italic>P</italic> &lt; 0.01]. Current users of ACEIs/ARBs seemed to have a higher rate of vasoconstrictive agents (20 vs. 6%, <italic>P</italic> &lt; 0.01) than the control group. Decreased lymphocyte counts [(0.76 ± 0.31) vs. (1.01 ± 0.45)<sup>*</sup>10<sup>9</sup>/L, <italic>P</italic> = 0.027] and elevated plasma levels of IL-10 [(9.91 ± 0.42) vs. (5.26 ± 0.21) pg/ml, <italic>P</italic> = 0.012] were also important discoveries in the ACEI/ARB group. Patients in the ACEI/ARB group had a prolonged duration of viral shedding [(24 ± 5) vs. (18 ± 5) days, <italic>P</italic> = 0.034] and increased length of hospitalization [(24 ± 11) vs. (15 ± 7) days, <italic>P</italic> &lt; 0.01]. These trends were similar in patients with hypertension.</p><p><bold>Conclusions:</bold> Our findings did not provide evidence for a significant association between ACEI/ARB treatment and COVID-19 mortality. ACEIs/ARBs might decrease proinflammatory cytokines, but antiviral treatment should be enforced, and hemodynamics should be monitored closely. Since the limited influence on the ACEI/ARB treatment, they should not be withdrawn if there was no formal contraindication.</p>