Should ACEI / ARB drugs be continued with hypertensive patients infected with Covid-19?

The Covid-19 pandemic caused unpredictable consequences with very high mortality rates in elderly patients, especially those with underlying medical conditions, including hypertension. However, in a study of 1128 patients with Covid-19-infected hypertension hospitalized in nine hospitals in Hubei, China showed that continued use of ACEI / ARB drugs reduced mortality. Bad pulmonary disease and changes in these patients.

1. The relationship between hypertension and Covid-19
Patients with underlying medical conditions such as hypertension often have high mortality rates when infected with SARS-CoV-2. The mechanism for Covid-19 to induce adverse changes in hypertensive patients is currently uncertain.

Hypotheses suggest that, when a patient is infected with Covid-19, over-activation of the RAS system may contribute to the progression of lung damage by promoting inflammatory response and cytokine storms, stimulating NADH / NADPH oxydase system and activates cellular and vasoconstriction. However, further studies are still needed to make this connection more clear.

2. Controversy
ACEI / ARB is the first group of drugs when used for patients with hypertension. Therefore, the main concern of many doctors and hospitals is whether to continue using ACEI / ARB for hypertensive patients or not.

The reason for this concern is that for patients with Covid-19-infected hypertension, whether the use of ACEI or ARB will affect is still a controversial issue. This is due to the ACE2 receptor, a known receptor that is essential for SARS-CoV-2 virus to invade and spread in the host cell.

ACE2 receptors are present in many organs in the body, including the digestive system, heart, and lungs. Initially people were concerned that using ACEI / ARB would increase the expression of ACE2 in the body, and this would facilitate the virus to spread rapidly, causing bad changes.

3. Research of scientists
On April 17, 2020, a study by scientists from different universities was published to clarify the issue. In this retrospective study, 1128 Covid-19-infected hypertension patients were admitted to 9 hospitals in Hubei province, China, which were divided into two groups: the ACEI / ARB group and the non-ACEI group. / ARB. The authors have come up with remarkable results such as:

– There were 99 deaths among 1128 patients, of which 7 cases (3.7%) were in the ACEI / ARB group and 92 cases (9.8%) were in the non-ACEI / ARB group .

– The non-ACEI / ARB group had a higher rate of fever, shortness of breath and lung damage.

– The rate of septic shock in patients using ACEI / ARB is 3.2% and the group not using ACEI / ARB is up to 8%

4. Clinical evidence supporting the continued use of ACEI / ARB for hypertensive patients with SARS-CoV-2 infection
Despite the controversies mentioned in section 2, the latest publications of the American Heart Association (AHA), the American Heart Association (HFSA), the American Heart University (ACC), the Association International Hypertension (ISH) still strongly supports the continued use of ACEI / ARB for covid-19 hypertensive patients. These claims are based primarily on the lack of clinical evidence to support the improvement or worsening of ACEI / ARB infection.

However, with the research of the scientists just mentioned in section 3, the clinical evidence is very clear and solid to support the continued use of ACEI / ARB in hypertensive patients. applying SARS-CoV-2 to reduce high mortality rate.

While clarifying studies still need to be done and the conclusions remain uncertain, ACEI / ARB continues to be the first-line drug for patients with acquired hypertension in the current situation. Covid-19.

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