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.