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

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          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.

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          A pneumonia outbreak associated with a new coronavirus of probable bat origin

          Peng Zhou, Xing-Lou Yang, Xian-Guang Wang … (2020)
          Since the outbreak of severe acute respiratory syndrome (SARS) 18 years ago, a large number of SARS-related coronaviruses (SARSr-CoVs) have been discovered in their natural reservoir host, bats 1–4 . Previous studies have shown that some bat SARSr-CoVs have the potential to infect humans 5–7 . Here we report the identification and characterization of a new coronavirus (2019-nCoV), which caused an epidemic of acute respiratory syndrome in humans in Wuhan, China. The epidemic, which started on 12 December 2019, had caused 2,794 laboratory-confirmed infections including 80 deaths by 26 January 2020. Full-length genome sequences were obtained from five patients at an early stage of the outbreak. The sequences are almost identical and share 79.6% sequence identity to SARS-CoV. Furthermore, we show that 2019-nCoV is 96% identical at the whole-genome level to a bat coronavirus. Pairwise protein sequence analysis of seven conserved non-structural proteins domains show that this virus belongs to the species of SARSr-CoV. In addition, 2019-nCoV virus isolated from the bronchoalveolar lavage fluid of a critically ill patient could be neutralized by sera from several patients. Notably, we confirmed that 2019-nCoV uses the same cell entry receptor—angiotensin converting enzyme II (ACE2)—as SARS-CoV.
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            Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention

            Zunyou Wu, Jennifer M. McGoogan (2020)
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              Effect of Renin-Angiotensin-Aldosterone System Inhibitors on Short-Term Mortality After Sepsis: A Population-Based Cohort Study

              Wan-Ting Hsu, Brandon Galm, Gregory Schrank … (2020)
              Antagonists of the renin-angiotensin-aldosterone system (RAAS), including ACEIs (angiotensin-converting enzyme inhibitors) and ARBs (angiotensin II receptor blockers), may prevent organ failure. We, therefore, investigated whether specific RAAS inhibitors are associated with reduced mortality in patients with sepsis.We conducted a population-based retrospective cohort study using multivariable propensity score–based regression to control for differences among patients using different RAAS inhibitors. A multivariable-adjusted Cox proportional-hazards regression model was used to determine the association between RAAS inhibitors and sepsis outcomes. To directly compare ACEI users, ARB users, and nonusers, a 3-way propensity score matching approach was performed. Results were pooled with previous evidence via a random-effects meta-analysis. A total of 52 727 patients were hospitalized with sepsis, of whom 7642 were prescribed an ACEI and 4237 were prescribed an ARB. Using propensity score–matched analyses, prior ACEI use was associated with decreased 30-day mortality (hazard ratio, 0.84 [95% CI, 0.75–0.94]) and 90-day mortality (hazard ratio, 0.83 [95% CI, 0.75–0.92]) compared with nonuse. Prior ARB use was associated with an improved 90-day survival (hazard ratio, 0.88 [95% CI, 0.83–0.94]). These results persisted in sensitivity analyses focusing on patients without cancer and patients with hypertension. By contrast, no beneficial effect was found for antecedent β-blockers exposure (hazard ratio, 0.99 [95% CI, 0.94–1.05]). The pooled estimates obtained from the meta-analysis was 0.71 (95% CI, 0.58–0.87) for prior use of ACEI/ARB.The short-term mortality after sepsis was substantially lower among those who were already established on RAAS inhibitor treatment when sepsis occurred.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Emerg Microbes Infect
                Journal ID (iso-abbrev): Emerg Microbes Infect
                Journal ID (publisher-id): TEMI
                Journal ID (publisher-id): temi20
                Title: Emerging Microbes & Infections
                Publisher: Taylor & Francis
                ISSN (Electronic): 2222-1751
                Publication date Collection: 2020
                Publication date (Electronic): 31 March 2020
                Volume: 9
                Issue: 1
                Pages: 757-760
                Affiliations
                [a ]National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology , Shenzhen, People’s Republic of China
                [b ]Shenzhen Bay Laboratory , Shenzhen, People’s Republic of China
                [c ]Lead Contact
                Author notes
                [CONTACT ] Hong Gao gaoh0508@ 123456163.com
                [*]

                These authors contributed equally.

                Author information
                http://orcid.org/0000-0002-3617-5449
                Article
                Publisher ID: 1746200
                DOI: 10.1080/22221751.2020.1746200
                PMC ID: 7170368
                PubMed ID: 32228222
                SO-VID: 51a45844-2596-4988-8a82-351a7041374e
                Copyright © © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group, on behalf of Shanghai Shangyixun Cultural Communication Co., Ltd
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 08 March 2020
                Date revision received : 16 March 2020
                Date accepted : 17 March 2020
                Page count
                Figures: 1, Tables: 0, Equations: 0, References: 12, Pages: 4
                Funding
                Funded by: National Natural Science Foundation of China 10.13039/501100001809
                Award ID: 81873958
                Funded by: China Postdoctoral Science Foundation 10.13039/501100002858
                Funded by: National Science and Technology Major Project for Control and Prevention of Major Infectious Diseases of China
                Funded by: State Key Laboratory of Respiratory Diseases Open Project 10.13039/100013262
                Funded by: Sanming Project of Medicine in Shenzhen 10.13039/501100012151
                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).
                Categories
                Subject: Letter

                Keywords: covid-19,hypertension,renin-angiotensin system,angiotensin-converting enzyme inhibitors,angiotensin ii type1 receptor blockers
                Data availability:
                Keywords: covid-19, hypertension, renin-angiotensin system, angiotensin-converting enzyme inhibitors, angiotensin ii type1 receptor blockers

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