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Differential effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on COVID-19
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  • Lianjiu su,
  • Jiahao Zhang,
  • nanhui jiang,
  • Juan Li,
  • Jie Yang,
  • Li He,
  • qin Xie,
  • rong huang,
  • fang Liu,
  • ying feng,
  • Kianoush Kashani,
  • rengyun liu,
  • qiaofa lu,
  • Zhiyong Peng
Lianjiu su
Wuhan University Zhongnan Hospital
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Jiahao Zhang
Wuhan University Zhongnan Hospital
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nanhui jiang
Wuhan University Zhongnan Hospital
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Juan Li
Huazhong University of Science and Technology
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Jie Yang
Huazhong University of Science and Technology
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Li He
Wuhan University Zhongnan Hospital
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qin Xie
Wuhan University Zhongnan Hospital
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rong huang
Wuhan University Zhongnan Hospital
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fang Liu
Wuhan University Zhongnan Hospital
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ying feng
Wuhan University Zhongnan Hospital
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Kianoush Kashani
Mayo Clinic
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rengyun liu
Sun Yat-sen University First Affiliated Hospital
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qiaofa lu
Huazhong University of Science and Technology
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Zhiyong Peng
Wuhan University Zhongnan Hospital
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Abstract

AIMS To report the major characteristics and clinical outcomes of COVID-19 patients treated with ACE inhibitors and ARBs and compare the different effects of the two drugs for outcomes of COVID-19 patients. METHODS This is a retrospective, two-center case series of 198 consecutive COVID-19 patients with a history of hypertension. RESULTS Among 198 patients, 58 (29.3%) and 16 (8.1%) were on were on ARB and ACEI, respectively. Patients who were on ARB or ACEI/ARB had a significantly lower rate of severe illness and ARDS when compared with patients treated with ACEI alone or not receiving RAAS blocker (P<0.05). The Kaplan-Meier survival curve showed that patients with ARB in their antihypertensive regimen had a trend towards a higher survival rate when compared with individuals without ARB (adjusted hazard ratio, 0.27; 95% CI, 0.07-1.02; P=0.054). The occurrence rates of severe illness, ARDS, and death were similar in the two groups regardless of receiving ACEI. The Cox-regression analysis to compared ACEI vs. ARB groups showed a significantly lower mortality rate in the ARB group (adjusted hazard ratio, 0.03; 95% CI, 0.00-0.58; P=0.02). CONCLUSIONS Our data may provide some evidence of using ARB, but not ACEI, was associated with a reduced rate of severe illness and ARDS, indicating their potential protective impact in COVID-19. Further large sample sizes and multiethnic populations are warranted to confirm our findings.