Angiotensin II receptor blocker intake associates with reduced markers of inflammatory activation and decreased mortality in patients with cardiovascular comorbidities and COVID-19 disease

  • Sebastian Cremer
  • Lisa Pilgram
  • Alexander Berkowitsch
  • Melanie Stecher
  • Siegbert Rieg
  • Mariana Shumliakivska
  • Denisa Bojkova
  • Julian Uwe Gabriel Wagner
  • Galip Servet Aslan
  • Christoph Spinner
  • Guillermo Luxán
  • Frank Hanses
  • Sebastian Dolff
  • Christiane Piepel
  • Clemens Ruppert
  • Andreas Guenther
  • Maria Madeleine Rüthrich
  • Jörg Janne Vehreschild
  • Kai Wille
  • Martina Haselberger
  • Hanno Heuzeroth
  • Arne Hansen
  • Thomas Eschenhagen
  • Jindrich Cinatl
  • Sandra Ciesek
  • Stefanie Dimmeler
  • Stefan Borgmann
  • Andreas Zeiher
  • LEOSS study group


AIMS: Patients with cardiovascular comorbidities have a significantly increased risk for a critical course of COVID-19. As the SARS-CoV2 virus enters cells via the angiotensin-converting enzyme receptor II (ACE2), drugs which interact with the renin angiotensin aldosterone system (RAAS) were suspected to influence disease severity.

METHODS AND RESULTS: We analyzed 1946 consecutive patients with cardiovascular comorbidities or hypertension enrolled in one of the largest European COVID-19 registries, the Lean European Open Survey on SARS-CoV-2 (LEOSS) registry. Here, we show that angiotensin II receptor blocker intake is associated with decreased mortality in patients with COVID-19 [OR 0.75 (95% CI 0,59-0.96; p = 0.013)]. This effect was mainly driven by patients, who presented in an early phase of COVID-19 at baseline [OR 0,64 (95% CI 0,43-0,96; p = 0.029)]. Kaplan-Meier analysis revealed a significantly lower incidence of death in patients on an angiotensin receptor blocker (ARB) (n = 33/318;10,4%) compared to patients using an angiotensin-converting enzyme inhibitor (ACEi) (n = 60/348;17,2%) or patients who received neither an ACE-inhibitor nor an ARB at baseline in the uncomplicated phase (n = 90/466; 19,3%; p<0.034). Patients taking an ARB were significantly less frequently reaching the mortality predicting threshold for leukocytes (p<0.001), neutrophils (p = 0.002) and the inflammatory markers CRP (p = 0.021), procalcitonin (p = 0.001) and IL-6 (p = 0.049). ACE2 expression levels in human lung samples were not altered in patients taking RAAS modulators.

CONCLUSION: These data suggest a beneficial effect of ARBs on disease severity in patients with cardiovascular comorbidities and COVID-19, which is linked to dampened systemic inflammatory activity.

Bibliografische Daten

StatusVeröffentlicht - 21.10.2021
PubMed 34673795