PDF(Pubmed)
Abstract：
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the coronavirus disease 2019 (COVID-19) pandemic, uses the surface angiotensin-converting enzyme 2 (ACE2) receptor as the site of entry into host cardiac, respiratory, intestinal, renal, and nervous system cells. Predisposing risk factors such as cardiovascular disease increase the risk of developing severe disease. Hypertension is characterized by the stimulation of the renin-angiotensin-aldosterone system (RAAS). Angiotensin-converting enzyme inhibitors (ACEis) and angiotensin 2 receptor blockers (ARBs), medications used to treat hypertension, inhibit RAAS and its downstream effects; however, they have also been shown to upregulate ACE2 receptors. In this review, we aim to evaluate the effectiveness of ACEi/ARBs as an adjunct therapy in patients with SARS-CoV-2 as well as examine the possible protective effects and impact on infection rate and disease severity. A PubMed literature search excluding sources outside the United States and duplicates was performed using the following search criteria: \"COVID-19 AND cardiovascular disease AND ACEi AND ARB\", \"SARS-COVID-19 OR COVID-19, AND ACEi AND ARB AND Infection rate\", \"COVID-19 AND ACEi and ARB\", \"Omicron BA.1 and BA.2 AND ACE2 OR ARBs\", \"Omicron AND ACEi AND ARBs\". This resulted in 33 final sources. The review concluded that ACEi/ARB therapy may continue to improve COVID-19 survival as previous treatment is associated with positive clinical outcomes. Patients taking ACEis or ARBs were found to have a decreased risk of hospitalization, reduced severity of COVID-19 pneumonia, a lesser need for mechanical ventilation, and an overall reduction in mortality rate. No statistically significant association between ACEi/ARB use and enhanced COVID-19 infectivity was found. The Omicron variant is theoretically more infectious and was associated with increased negative clinical outcomes in those undertreated with ACEis/ARBs. The majority of the literature supports the current guidelines from the American College of Cardiology (ACC), American Heart Association (AHA), European Society of Cardiology (ESC), and Heart Failure Society of America (HFSA), which state that ACEi and ARB medications should not be withdrawn from or initiated on patients with cardiovascular disease who are infected with SARS-CoV-2. More research needs to be conducted on the association between the emerging COVID-19 variants and ACEis/ARBs to give clinicians confidence when treating patients within this subgroup of the population.
摘要：
严重急性呼吸道综合征冠状病毒2（SARS-CoV-2），导致2019年冠状病毒病(COVID-19)大流行的病毒，使用表面血管紧张素转换酶2（ACE2）受体作为进入宿主心脏的部位，呼吸,肠,肾,和神经系统细胞。心血管疾病等易感危险因素会增加患严重疾病的风险。高血压的特征是肾素-血管紧张素-醛固酮系统（RAAS）的刺激。血管紧张素转换酶抑制剂（ACEis）和血管紧张素2受体阻滞剂（ARBs），用于治疗高血压的药物，抑制RAAS及其下游效应；然而，它们还被证明可以上调ACE2受体。在这次审查中,我们旨在评估ACEi/ARBs作为SARS-CoV-2患者辅助治疗的有效性,并研究可能的保护作用以及对感染率和疾病严重程度的影响.PubMed文献检索不包括美国以外的来源，并使用以下检索标准进行重复：“COVID-19与心血管疾病和ACEi和ARB”，“SARS-COVID-19或COVID-19，以及ACEi和ARB和感染率”，“COVID-19和ACEi和ARB”，\"OmicronBA.1和BA.2和ACE2或ARBs\",\“奥米克隆、ACEi和ARBs\”。这导致了33个最终来源。该评价的结论是，ACEi/ARB治疗可能会继续改善COVID-19的生存率，因为以前的治疗与积极的临床结果相关。发现服用ACEis或ARBs的患者住院风险降低，降低COVID-19肺炎的严重程度，较少需要机械通气，和死亡率的整体下降。ACEi/ARB的使用与COVID-19传染性增强之间没有统计学上的显著关联。Omicron变异在理论上更具传染性，并且在接受ACEis/ARBs治疗的患者中与阴性临床结果增加相关。大多数文献支持美国心脏病学会（ACC）的现行指南，美国心脏协会（AHA）欧洲心脏病学会（ESC），和美国心力衰竭协会（HFSA），其中指出，ACEi和ARB药物不应从感染SARS-CoV-2的心血管疾病患者中撤出或开始使用。需要对新出现的COVID-19变体与ACEis/ARB之间的关联进行更多的研究，以使临床医生在治疗此亚组患者时充满信心。
