Evidence suggests no COVID-19-related harm from RAAS antagonists

Because the virus that causes COVID-19 acts through the ACE2 receptor, there was concern that use of renin-angiotensin-aldosterone system antagonists such as ACE inhibitors and angiotensin receptor blockers, which are used to treat hypertension, HF and other CV conditions, might predispose people to COVID-19 or worsen its effects. But emerging data suggest that concern is unfounded.To get more news about RaaS, you can visit glprobotics.com official website.

“We now have at least 11 observational studies that have reported on this issue. They are of varying quality, but some are very good studies, albeit none are randomized controlled trials. Overall, they are quite consistent in failing to show a relationship between renin-angiotensin-aldosterone system (RAAS) inhibitors and COVID-19 infection or severe/fatal complications,” Paul K. Whelton, MB, MD, MSc, Show Chwan Professor of Global Public Health, department of epidemiology, Tulane University School of Public Health and Tropical Medicine and Tulane University of Medicine, told Healio.

Taken together, the findings confirm recommendations released in March by various cardiology societies, including the American College of Cardiology, the American Heart Association, the European Society of Cardiology and the Heart Failure Society of America, that patients on RAAS antagonists continue to take them.
The question came up because these medications upregulate the same receptor that the virus is using to enter the host cells,” Ankur Kalra, MD, FACP, FACC, FSCAI, assistant professor of medicine at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University and staff interventional cardiologist in the department of cardiovascular medicine, Heart, Vascular and Thoracic Institute at Cleveland Clinic, told Healio. “Also, the earlier data that came out from China and Italy showed that patients with underlying disease conditions, particularly hypertension and heart disease, were at an increased risk. It even compounded the theory as to whether these medications are putting them at heightened risk for contracting the infection.”
The studies published so far all suggest that people taking RAAS inhibitors are not more likely to test positive for COVID-19 nor more likely to die of it if they contract it.

In one study published in The New England Journal of Medicine by Mandeep R. Mehra, MD, The William Harvey Distinguished Chair in Advanced Cardiovascular Disease at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School, and colleagues, in a cohort of 8,910 patients with COVID-19 from three continents, there was no elevated risk for in-hospital death from use of ACE inhibitors (users, 2.1%; nonusers, 6.1%; OR = 0.33; 95% CI, 0.2-0.54) or angiotensin receptor blockers (users, 6.8%; nonusers, 5.7%; OR = 1.23; 95% CI, 0.87-1.74).

In a cohort of 12,594 patients documented in the NYU Langone Health electronic health record to have been tested for COVID-19 between March 1 and April 15, there was no relationship between a positive test for COVID-19 and use of any class of BP medication, including ACE inhibitors and/or angiotensin receptor blockers, beta-blockers, calcium channel blockers and thiazide-type diuretics, Harmony R. Reynolds, MD, associate professor of medicine and associate director of the Cardiovascular Clinical Research Center at NYU Grossman School of Medicine, and colleagues reported in NEJM.

“The most important take-home message from our study is that it is safe to take heart and blood pressure medications, including ACE inhibitors/angiotensin receptor blockers,” Reynolds told Healio. “Even though the study did not address mechanisms of the interaction of the virus with the drugs, we see no harm in the large group of patients studied, and that should be reassuring for all patients taking ACE inhibitors and angiotensin receptor blockers, including during the pandemic.”

In a case-control study from Florence, Italy, published in NEJM, use of ACE inhibitors and angiotensin receptor blockers was more common in 6,272 patients with COVID-19 compared with 30,759 matched controls, but among the cases, there was no association with their use and COVID-19 or their use and a severe or fatal course.