Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Ji'nan, China.
Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong University, Ji'nan, China.
J Cell Mol Med. 2021 Dec;25(23):11031-11034. doi: 10.1111/jcmm.17051. Epub 2021 Nov 11.
The administration of ACEI/ARB (angiotensin-converting enzyme inhibitors/Angiotension II receptor blockers) in COVID-19 (coronavirus disease 2019) patients with hypertension exhibits a lower risk of mortality compared with ACEI/ARB non-users. In this context, an important question arises: is ACEI or ARB more suitable for the treatment of hypertensive COVID-19 patients? Taken into consideration the following four rationales, ARB may offer a more significant benefit than ACEI for the short-term treatment of hypertensive COVID-19 patients: 1. ACEI has no inhibition on non-ACE-mediated Ang II production under infection conditions, whereas ARB can function properly regardless of how Ang II is produced; 2. ACEI-induced bradykinin accumulation may instigate severe ARDS while ARB has no effects on kinin metabolism; 3. ARB alleviates viscous sputa production and inflammatory reaction significantly in contrast to ACEI; 4. ARB may attenuate the lung fibrosis induced by mechanical ventilation in severe patients and improve their prognosis significantly compared with ACEI. To examine the advantages of ARB over ACEI on hypertensive COVID-19 patients, retrospective case-control studies comparing the clinical outcomes for COVID-19 patients receiving ARB or ACEI treatment is strikingly needed in order to provide guidance for the clinical application.
在伴有高血压的 COVID-19（2019 年冠状病毒病）患者中，血管紧张素转换酶抑制剂/血管紧张素 II 受体阻滞剂（ACEI/ARB）的给药与 ACEI/ARB 非使用者相比，死亡率风险较低。在这种情况下，出现了一个重要问题：ACEI 或 ARB 更适合治疗高血压 COVID-19 患者？考虑到以下四个理由，ARB 可能比 ACEI 更适合高血压 COVID-19 患者的短期治疗：1. 在感染条件下，ACEI 对非 ACE 介导的 Ang II 产生没有抑制作用，而 ARB 可以正常发挥作用，无论 Ang II 如何产生；2. ACEI 诱导的缓激肽积累可能引发严重的 ARDS，而 ARB 对激肽代谢没有影响；3. ARB 可显著减轻粘性痰液的产生和炎症反应，而 ACEI 则没有这种作用；4. ARB 可能减轻重症患者机械通气引起的肺纤维化，并显著改善其预后，优于 ACEI。为了研究 ARB 对高血压 COVID-19 患者的优势，迫切需要进行比较 ARB 和 ACEI 治疗 COVID-19 患者的临床结局的回顾性病例对照研究，以便为临床应用提供指导。
