Insights from Clinical Trial
At present many clinical trials are listed in the WHO’s website and clinicaltrials.gov. which are in progress around the world (table 1). One of such study conducted in nine hospitals in Hubei province of China. which recruited total of 3611 patients, showed ACEI/ARB receiving patients had lower risk of COVID-19 mortality than non-ACEI/ARB (Zhang et al., 2020). The incidence of septic shock was also lower in ACEI/ARB group than non-ACEI/ARB group of patients. Another study, done at King’s College Hospital and Princess Royal University Hospital, London, UK, recruited total of 205 patients with 51·2% hypertensive patients, 30·2% diabetic patients and 14·6% patients with ischemic heart disease or heart failure, and has shown reduced risk of rapidly deteriorating COVID-19 in the ACE inhibitor-treated patients (Bean et al., 2020).
In yet another study, done at Shenzhen Third People’s Hospital, China, a total of 417 patients was recruited (Meng et al., 2020). Among them, 17 patients were categorized in the ACEI/ARB group and 25 patients in the non-ACEI/ARB group. The median number of days from the onset of symptoms to hospital admission was 3.0 in the ACEI/ARB group and 2.0 in the non-ACEI/ARB group. Moreover, ACEI/ARB group of patients had lower IL-6 expression than non-ACEI/ARB group, significantly lower peak viral load during hospitalization and higher CD8+ T cells. Another similar study, from Hubei Provincial Hospital of Traditional Chinese Medicine, China, recruited 462 COVID-19 patients in which 126 (27.2%) patients were hypertensive and 125 were normotensive patients (Yang et al., 2020). Hypertensive patients on ACEI/ARB had a much lower death rate than those on non-ARBs/ACEIs medications. Patients with ACEI/ARB medication had lower concentration of CRP and procalcitonin than non-ACEI/ARB medication, pointing to possible anti-inflammatory effects. In a multicentric study done at Shenzhen Third People’s hospital (Shenzhen, China), Renmin Hospital of Wuhan University (Wuhan, China) and Fifth Medical Center of People’s Liberation Army General Hospital (Beijing, China), the data showed, among the elderly (age>65) COVID-19 patients with hypertensive co-morbidity, the risk of severe COVID-19 was significantly lowered with ARB administration (Liu et al., 2020b).
More of such studies are still ongoing around the world, which definitely will provide further insights in days to come. These clinical studies have certain limitations such as low numbers of patients were recruited death of patients during medication and are yet to be published post-peer-review. Nevertheless, all these studies have suggested that the usage of ACEI and ARBs was associated with better prognosis in hypertensive patient suffering from COVID-19.
Table 1. Data from clinical trials that are listed in the WHO’s website