Introduction
The novel coronavirus SARS-CoV-2, which has caused a pandemic of
coronavirus disease 2019 (COVID-19), has become a serious threat to
human health globally. This disease particularly poses a tremendous
hazard to individuals with coexisting comorbidities, including old age
and chronic diseases such as hypertension, diabetes mellitus, and
chronic lung diseases 1,2. Similar to SARS-CoV,
SARS-CoV-2 utilizes angiotensin-converting enzyme-2 (ACE2) protein on
the cell membrane as its host receptor3.
Angiotensin-Converting Enzyme Inhibitors (ACEI) and Angiotensin II
Receptor Blockers (ARB) are commonly used in hypertensive in COVID-19
patients with hypertension. Thus, there is an increasing interest in the
potential effects of these drugs on the outcomes of patients with
COVID-194. Recently, in a Chinese retrospective study,
Zhang et al. reported ACEI/ARB to exhibit a remarkable association with
reduced mortality of COVID-19 patients with
hypertension5. A similar study by Li et al. showed
ACEI/ARB not affecting the outcome of COVID-19 patients. However, there
may be some differences between the use of ACEI vs. ARB on the outcomes.
On the other hand, a previous study showed that the ACEI and ARB
differed in the expression of ACE2 in an animal
experiment6, suggesting the possibility of
differential effects on COVID-19 patients. Of note, it has been reported
that East Asian patients have higher incidence of ACEI-induced
cough7. Therefore, ARB is the predominant drug used in
China to block the renin-angiotensin-aldosterone system (RAAS). As the
effect of ACEI/ARB on the outcomes of COVID-19 patients is still
controversial, we aimed to assess the characteristics and clinical
outcomes of patients with a history of hypertension treated with ACEI
vs. ARB who developed COVID-19.