Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers and clinical outcomes of COVID-19

Dear Editor, we would like to share ideas on the publication “The divergent protective effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on clinical outcomes of coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis (1)” Flego et al. found that “neither ACEIs nor ARBs worsen the clinical outcomes of COVID-19 ... treatment interruption of ACEI or ARB therapy during COVID-19 infection is not recommended. (1).” We agree that there might be an effect of ACEI antihypertensive agent on COVID-19. Indeed, some new reports mention for usefulness of ACEI (2,3) whereas the others report opposite finding (4). Several factors influence the COVID-19 patient’s clinical outcome. The outcome may be influenced by the underlying health status, immunity, and a concurrent medical problem. Moreover, since there is no standard therapy for COVID-19, different therapies can have varying outcomes. In the present report, a subgroup analysis on those confounding factors might be necessary.

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Footnote

Provenance and Peer Review: This article was a standard submission to the journal. The article did not undergo external peer review.

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://apm.amegroups.com/article/view/10.21037/apm-22-131/coif). The authors have no conflicts of interest to declare.

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References

1. Xie Q, Tang S, Li Y. The divergent protective effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on clinical outcomes of coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis. Ann Palliat Med 2021; Epub ahead of print. [Crossref] [PubMed]
2. Martínez-Urbistondo M, Moreno-Torres V, Mora-Vargas A, et al. Interaction of ACEI antihypertensive agent's administration with the inflammatory status at admission concerning COVID-19 clinical stay outcomes. Vascul Pharmacol 2022;143:106955. [Crossref] [PubMed]
3. Thomas SA, Puskarich M, Pulia MS, et al. Association Between Baseline Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers and Death Among Patients Tested for COVID-19. J Clin Pharmacol 2021; Epub ahead of print. [Crossref] [PubMed]
4. Rizk JG, Wenziger C, Tran D, et al. Angiotensin-Converting Enzyme Inhibitor and Angiotensin Receptor Blocker Use Associated with Reduced Mortality and Other Disease Outcomes in US Veterans with COVID-19. Drugs 2022;82:43-54. [Crossref] [PubMed]