Research on the impact of ACE-i and ARBs for patients with COVID-19
continues to evolve

Date:
September 10, 2020
Source:
American Heart Association
Summary:
Low blood pressure, or hypotension, in COVID-19 patients with a
history of hypertension appears to be a risk factor for kidney
damage and death.

Reducing hypertension medications if and when COVID-19 patients
become hypotensive could prevent acute kidney injury and death,
according to a new study. A different study confirmed hypertension
is the most common co-existing disease in hospitalized COVID-19
patients. A third, small study found hospitalized, COVID-19
patients previously taking the blood pressure-lowering drugs
angiotensin-converting enzyme inhibitors (ACE-i) and angiotensin
receptor blockers (ARBs) are more likely to die than those who
were not taking the medications.



FULL STORY ========================================================================== Reducing or eliminating high blood pressure medications if blood
pressure becomes hypotensive, falling below 120/70 mm Hg, could prevent
acute kidney injury and death in COVID-19 patients, according to new
research to be presented Sept. 10-13, 2020, at the virtual American Heart Association's Hypertension 2020 Scientific Sessions. The meeting is a
premier global exchange for clinical and basic researchers focusing on
recent advances in hypertension research.


========================================================================== Early in the COVID-19 pandemic, the American Heart Association issued a
joint statement with the Heart Failure Society of America and the American College of Cardiology to address the use of ACE-i and ARB medications
among patients at risk for developing COVID-19. Recommendations called for
the continuation of ACE-i or ARB medications among patients already taking
them for indications such as heart failure, hypertension or ischemic heart disease. Cardiovascular disease patients who are diagnosed with COVID-19
should be fully evaluated before adding or removing any treatments, and
any changes to their treatment should be based on the latest scientific evidence and shared-decision making with their physician and health
care team.

"While we continue to learn more about the complex impact of COVID-19
every day, we know that people with cardiovascular disease and/or
hypertension are at much higher risk for serious complications including
death from COVID-19," said Mariell Jessup, M.D., FAHA, chief science
and medical officer of the American Heart Association. "We continue to
monitor and review the latest research, and we strongly recommend all physicians to consider the individual needs of each patient before
making any changes to ACE-i or ARB treatment regimens. The latest
research findings do suggest, however, that these medications should
be discontinued in patients who develop hypotension in order to avoid
severe kidney damage." "Acute kidney injury, also known as acute kidney failure, is a serious COVID-19 complication, and many people with the
virus are at risk," according to study author Paolo Manunta, M.D., Ph.D.,
chair of nephrology at San Raffaele University in Milan, Italy.

To determine which COVID-19 patients are most at risk for kidney damage (#P145), Manunta and colleagues studied 392 COVID-19 patients hospitalized between March 2 and April 25, 2020, treated at one center in Italy
(#P145).

They found:
* Nearly 60% had a history of hypertension, making it the most
common co-
occurring health issue in these patients.

* More than 86% of patients with high blood pressure were taking anti-
hypertensive medications daily.

* Overall, 6.2% of the patients came into the emergency department
with
acute kidney injury -- kidney function and hypertension were the
main determinants of whether a person had acute kidney injury.

* Having a history of hypertension increased the risk of acute kidney
injury by about five-fold.

* Patients presenting to the emergency department who had severe
hypotension, meaning blood pressure lower than 95/50 mm Hg, were
nine times more likely to have acute kidney injury; while those
who had mild hypotension, blood pressure lower than 120/70 mm Hg
but not in the severe range, were four times more likely to have
acute kidney injury.

* COVID-19 patients who were more likely to develop acute kidney
injury
while hospitalized were elderly, hypertensive or had severe
respiratory distress.

* However, overall, in-hospital death was twice as likely in
patients with
mild hypotension when they arrived at the emergency department,
regardless of age, other diseases and COVID-19 severity.

"Our study suggests low blood pressure in a person with a history of high
blood pressure is an important and independent signal that someone with COVID-19 is developing or has acute kidney injury," Manunta said. "This
also suggests that people with high blood pressure should carefully
monitor it at home, and their kidney function should be measured when
they're first diagnosed with COVID-19.

If they or their doctors notice blood pressure levels going down to
the hypotensive range, their doctors may consider reducing or stopping
their blood pressure medications to prevent kidney damage and possibly
even death."


========================================================================== Study limitations include its relatively small sample size in a
single-center population and the brevity of the study period.

Co-authors are Chiara Livia Lanzani, M.D.; Marco Simonini, M.D;
Elisabetta Messaggio, B.S.; Teresa Arcidiacono, M.D.; Paolo Betti, M.D.;
Romina Bucci, M.D.; Fontana Simonet, M.D.; Caterina Conte, M.D.; Giuseppe Vezzoli, M.D.; Patrizia Rovere-Querini, M.D., Ph.D.; Conte Caterina M.D.;
and Ciceri Fabio M.D., Ph.D. IRCCS San Raffaele funded this study.

Pre-existing high blood pressure common in those hospitalized for COVID-19 (#P135) In another study presented at the meeting, researchers confirmed previous findings that hypertension is the most common co-existing
disease among hospitalized COVID-19 patients.

They analyzed 22 studies from eight countries with more than 11,000
total, hospitalized COVID-19 patients. Researchers found 42% of patients
had hypertension, followed by diabetes mellitus, which affected 23%
of patients.



========================================================================== Hypertension, alone, was associated with a higher likelihood of death.

Surprisingly, hypertension was notably more common than the lung disease chronic obstructive pulmonary disease (COPD) among hospitalized COVID-19 patients, according to the researchers.

"More randomized studies are needed to assess the effect of hypertension
on mortality in COVID-19 patients," said researchers in the abstract.

Authors are Vikramaditya Reddy Samala Venkata, M.D.; Rahul Gupta, M.D.;
and Surya Kiran Aedma, M.D.

Common blood pressure-lowering drugs may pose increased risks for COVID-19 patients (#P144) In a third study from the meeting, researchers at the University of Miami/JFK Medical Center in Atlantis, Florida, studied hospitalized COVID-19 patients to determine the effects of taking the
blood pressure-lowering prescriptions angiotensin-converting enzyme
inhibitors (ACE-i) and/or angiotensin receptor blockers (ARBs). They
found that patients taking the medications were more likely to die than
those who were not taking them.

In the single-center, retrospective study, researchers studied 172
patients hospitalized for COVID-19 between March and May 2020. They found
33% of patients taking one or both of the anti-hypertensive medications
(ACE-i, ARBs) died in the hospital, versus 13% of those not taking either
of the medications.

Admission to the intensive care unit was also higher -- at 28% among
those on the medications versus 13% of patients not taking ACE-i and/or
ARB medications.

The higher risk of death among patients taking the antihypertensive
medications could be because people prescribed those medications tend to
be older and are more likely to have diabetes mellitus and hypertension, researchers noted in the abstract.

Study authors are Baher Al-Abbasi, M.D.; Nakeya Dewaswala, M.D.; Fergie
Ramos, M.D.; Ahmed Abdallah, M.D.; Pedro Torres, M.D.; Kai Chen, M.D.;
Mohamed Abdul Qader, M.D.; Samar Aboulenain, M.D.; Karolina Dziadkowiec,
M.D.; Jesus Pino, M.D.; and Robert D Chait, M.D.


========================================================================== Story Source: Materials provided by American_Heart_Association. Note:
Content may be edited for style and length.


==========================================================================


Link to news story: https://www.sciencedaily.com/releases/2020/09/200910150334.htm

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