Abstract
Aim: Angiotensin-converting enzyme 2 (ACE2) has a significant
physiological role in the renin – angiotensin – aldosterone system
(RAAS) pathway. The ACE2 receptor acts as a virus receptor in the
pathogenesis of severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2) disease. In this study, we aimed to investigate the effects
of ACEIs use on radiological imaging and clinical course in COVID-19.
Methods: In this study, patients who had been using medications
for the diagnosis of hypertension and who were hospitalized in
Haydarpasa Numune Training and Research Hospital due to COVID-19
pneumonia were retrospectively evaluated.
Results: The mean age of 107 patients included in this study
was 68,49±11,95, and 50.5% (n = 54) of them were male. The patients
were divided into two separate study groups as ACEIs users and
non-users. In the first of these groups, 55 patients were using ACEIs
due to hypertension. In the second group, 52 patients were using calcium
channel blockers (CCBs), β-blockers, alpha-2 blockers, or diuretics,
alone or in combination. When the lung computed tomography images were
examined, multilobar findings were less common in the ACEIs group, which
was remarkable (p <0.001). When the clinical endpoint was
evaluated, the findings showed that the mortality rates were different
in the groups ACEIs users and non-users (12.7% vs. 32.7%,
respectively, p=0.013).
Conclusion: Although the role of RAAS blockade in COVID-19 is
still not fully elucidated, we have shown that COVID-19 progresses with
less damage in the lungs with patients who have been using ACEIs.
Keywords: ACEIs, COVID-19, Multilobar lesions, Radiographic
findings
Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues
to be a significant public health problem, affecting more than 50
million people worldwide. Although the mortality rate is below 5%1, its mortality is significantly higher in
individuals with a history of diabetes, hypertension, cardiovascular
disease, or cerebrovascular disease, which has aroused considerable
interest in the pathophysiological mechanisms triggered by this
infection 2. Studies have shown that the novel-type
coronavirus is from the betacoronavirus family, such as SARS-CoV and
MERS-CoV, and is similar to the bat coronavirus with >95%
homology 3. It has also been shown in genomic analyses
that the SARS-CoV-2 genome sequence is more than 75% similar to the
SARS-CoV genome 4. Concerning its clinical course, the
novel type of coronavirus may lead to severe pneumonic involvement
similar to SARS-CoV and MERS-CoV 5.
SARS-CoV acts through angiotensin-converting enzyme 2 (ACE2) receptor6, 7. ACE 2 receptor, which is highly expressed in
lung alveolar epithelial cells besides heart, kidney, and vascular
endothelium tissues, is also considered to act as the receptor that
initiates cellular infection of the new type of coronavirus6. The efficacy of angiotensin-converting enzyme
inhibitors (ACEIs), which have been used safely in the treatment of
hypertension for many years, is supported by hard evidence in the
treatment of heart failure, post-myocardial infarction, and
diabetes-related kidney failure 8. Whether ACEIs use
is effective against COVID 19 infection remains a matter of debate yet.
Although it is considered that the number of ACE2 receptors will be
up-regulated as a result of the ACEIs use, it will be easier for the
virus to infect the cell 1, this opinion has not been
confirmed with clarity.
In this study, we aimed to evaluate the epidemiological features,
clinical features, and findings in lung computed tomography of patients
who were diagnosed with COVID-19 and who were using ACEIs for
hypertension since before this diagnosis.