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

Abstract

Objectives: 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. Methods: 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 (n = 38) or control group (n = 114) according to whether they were current users of medication. Results: Compared to the control group, patients in the ACEI/ARB group had lower levels of plasma IL-1 beta [(6.20 +/-& nbsp;0.38) vs. (9.30 +/- 0.31) pg/ml, P = 0.020], IL-6 [(31.86 +/- 4.07) vs. (48.47 +/- 3.11) pg/ml, P = 0.041], IL-8 [(34.66 +/-& nbsp;1.90) vs. (47.93 +/- 1.21) pg/ml, P = 0.027], and TNF-alpha [(6.11 +/- 0.88) vs. (12.73 & PLUSMN; 0.26) pg/ml, P < 0.01]. Current users of ACEIs/ARBs seemed to have a higher rate of vasoconstrictive agents (20 vs. 6%, P < 0.01) than the control group. Decreased lymphocyte counts [(0.76 +/-& nbsp;0.31) vs. (1.01 +/-& nbsp;0.45)*10(9)/L, P = 0.027] and elevated plasma levels of IL-10 [(9.91 +/- 0.42) vs. (5.26 +/- 0.21) pg/ml, P = 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, P = 0.034] and increased length of hospitalization [(24 +/- 11) vs. (15 +/- 7) days, P < 0.01]. These trends were similar in patients with hypertension. Conclusions: 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 Since the limited influence on the ACEI/ARB treatment, they should not be withdrawn if there was no formal contraindication.