Assessing the outcomes of prescribing angiotensin converting enzyme inhibitors and angiotensin receptor blockers for COVID-19 patients

Wissam Mekary; Souha Fares; Farah Abdulhai; Gaelle Massoud; Marwan Refaat; Mathias Mericskay; George W Booz; Fouad A Zouein

doi:10.1016/j.heliyon.2023.e19373

Assessing the outcomes of prescribing angiotensin converting enzyme inhibitors and angiotensin receptor blockers for COVID-19 patients

Heliyon. 2023 Aug 22;9(9):e19373. doi: 10.1016/j.heliyon.2023.e19373. eCollection 2023 Sep.

Authors

Wissam Mekary^{1

2}, Souha Fares³, Farah Abdulhai^{4

5}, Gaelle Massoud^{1

2

6}, Marwan Refaat^{4

5}, Mathias Mericskay⁷, George W Booz⁸, Fouad A Zouein^{1

2

7

8}

Affiliations

¹ Department of Pharmacology and Toxicology, American University of Beirut Medical Center, Faculty of Medicine, Beirut, Lebanon.
² The Cardiovascular Renal And Metabolic Diseases Research Center of Excellence, American University of Beirut Medical Center, Faculty of Medicine, Beirut, Lebanon.
³ Hariri School of Nursing, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
⁴ Department of Internal Medicine, Cardiovascular Medicine/Cardiac Electrophysiology, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon.
⁵ Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon.
⁶ Department of Gynecology and Obstetrics, Division of Reproductive Sciences & Women's Health Research, Johns Hopkins Medicine, Baltimore, USA.
⁷ Department of Signaling and Cardiovascular Pathophysiology, UMR-S 1180, Inserm, Université Paris-Saclay, France.
⁸ Department of Pharmacology and Toxicology, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.

Abstract

Background: Patients with heart failure were affected severely by COVID-19. Most heart failure patients are on guideline directed medical therapy, which includes ACE inhibitors (ACEI) and ARBs. These medications were controversial at the beginning of the pandemic due to their interplay with the receptor that SARS-CoV-2 binds in the lungs. We investigated the effect that ACEI and ARB had on patients with hypertension, coronary artery disease, and heart failure.

Methods: We recruited 176 patients with COVID-19 infection and cardiovascular comorbidities at the American University of Beirut Medical Center in Lebanon. Of these, 110 patients were taking ACEI or ARB and 66 were not. We collected clinical data and looked at inflammatory markers such as CRP and IL-6 and cardiac markers such as troponin T. We also reported the incidence of ARDS, sepsis, and death of each patient, and compared the 2 groups.

Results: We found that patients taking ACEI and ARB had a statistically significant decrease in levels of troponin T, IL-6, and CRP compared to patients not taking these medications (p < 0.05). We found no difference in rates of ARDS, sepsis, or death between the 2 groups.

Conclusion: Inhibition of the renin-angiotensin-aldosterone-system had no effect on the mortality of patients with COVID-19 and on their overall disease progression. However, it may be beneficial not to stop these medications as they decrease inflammation in the body and the levels of troponin, which are related to increased stress on the heart.

Keywords: Cardiac biomarkers; Cytokines; Inflammation; Inflammatory biomarkers; Renin angiotensin aldosterone system; SARS-CoV-2.