PLoS ONE (Jan 2021)

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

DOI
https://doi.org/10.1371/journal.pone.0258684
Journal volume & issue
Vol. 16, no. 10
p. e0258684

Abstract

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AimsPatients 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 resultsWe 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%; pConclusionThese 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.