The dynamics of hypertension and renal function in CKD and non-CKD patients affected with COVID-19 – final results of BIRCOV trial
DOI:
https://doi.org/10.15584/ejcem.2023.2.3Keywords:
ACEi, ARB, BIRCOV trial, COVID-19, DRi, iRASAbstract
Introduction and aim. There is evidence in the literature about a change in the effectiveness of inhibitors of the renin-angiotensin system (iRAS) in people with COVID-19. Considering different mechanisms of pressure reduction by different iRAS groups, one can expect differences in people with COVID-19 receiving these drugs. The aim of angiotensin-converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARB) and direct renin inhibitors (DRi) usage in COVID-19 (BIRCOV study) was to pinpoint clinical and laboratory differences in people with hypertension who received iRAS and suffered coronavirus infection.
Material and methods. An open prospective trial of 108 patients was performed in subjects suffering from COVID-19 who have been receiving iRAS: ACEi, ARB or DRi as basic antihypertensive therapy. The disease follow-up was 12 and 24 weeks. A blood pressure (BP) measurement was performed the week before COVID-19 and up to 24 weeks from the disease onset. Subanalysis in patients with chronic kidney disease (CKD) was performed.
Results. In patients with COVID-19, a change in the effectiveness of antihypertensive therapy depending on the type of drug in the iRAS group has been documented in the first 4 weeks from the onset of the disease. The use of ACEi had significantly increased the risk of severe hypotension, unlike ARBs that do not cause hypotension. The synchronous decline of estimated glomerular filtration rate (eGFR) and systolic BP was more pronounced in CKD patients followed by albuminuria incidence. The greatest decrease in eGFR was in people taking ACEi.
Conclusion. People with grade 1-2 hypertension who are constantly receiving RAS inhibitors suffering from COVID-19 may develop hypotension with ACEi. COVID-19 leads to transient albuminuria and decreased glomerular filtration rate, which is especially dangerous for people with CKD 4-5.
Downloads
References
Beyerstedt S, Casaro EB, Rangel É B. COVID-19: angiotensin-converting enzyme 2 (ACE2) expression and tissue susceptibility to SARS-CoV-2 infection. Eur J Clin Microbiol Infect Dis. 2021;40(5):905-919. doi: 10.1007/s10096-020-04138-6
Bojkova D, Klann K, Koch B, et al. Proteomics of SARS-CoV-2-infected host cells reveals therapy targets. Nature. 2020;583(7816):469-472. doi: 10.1038/s41586-020-2332-7.
Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med. 2020;8(4):e21. doi: 10.1016/S2213-2600(20)30116-8
Davidson AD, Williamson MK, Lewis S, et al. Characterisation of the transcriptome and proteome of SARS-CoV-2 reveals a cell passage induced in-frame deletion of the furin-like cleavage site from the spike glycoprotein. Genome Med. 2020;12(1):68. doi: 10.1186/s13073-020-00763-0
Mehra MR, Desai SS, Kuy S, Henry TD, Patel AN. Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19. N Engl J Med. 2020;382(25):e102. doi: 10.1056/NEJMoa2007621
Kerneis M, Montalescot G. RAS inhibition and COVID-19: more questions than answers? Lancet Respir Med. 2021;9(8):807-809. doi: 10.1016/S2213-2600(21)00233-2
Bauer A, Schreinlechner M, Sappler N, et al. Discontinuation versus continuation of renin-angiotensin-system inhibitors in COVID-19 (ACEI-COVID): a prospective, parallel group, randomised, controlled, open-label trial Lancet Respir Med. 2021;9(8):863-872. doi: 10.1016/S2213-2600(21)00214-9
ERA-EDTA Council; ERACODA Working Group. Chronic kidney disease is a key risk factor for severe COVID-19: a call to action by the ERA-EDTA. Nephrol Dial Transplant. 2021;36(1):87-94. doi: 10.1093/ndt/gfaa314
Reynolds HR, Adhikari S, Pulgarin C, et al. Renin-Angiotensin-Aldosterone System Inhibitors and Risk of Covid-19. N Engl J Med. 2020;382(25):2441-2448. doi: 10.1056/NEJMoa2008975
Mourad JJ, Levy BI. Interaction between RAAS inhibitors and ACE2 in the context of COVID-19. Nat Rev Cardiol. 2020;17(5):313. doi: 10.1038/s41569-020-0368-x
Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension Eur Heart J. 2018;39(33):3021-3104. doi: 10.1093/eurheartj/ehy339
Flack JM, Adekola B. Blood pressure and the new ACC/AHA hypertension guidelines. Trends Cardiovasc Med. 2020;30(3):160-164. doi: 10.1016/j.tcm.2019.05.003
Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney Int. 2021;99(3S):S1-S87. doi: 10.1016/j.kint.2020.11.003
Ivanova MD, Gozhenko AI, Crestanello T, Ivanov DD. Early Coaching to Increase Water Intake in CKD. Ann Nutr Metab. 2020;76, 1:69-70. doi: 10.1159/000515276
Li D, Ren H, Varelmann DJ, et al. Risk assessment for acute kidney injury and death among new COVID-19 positive adult patients without chronic kidney disease: retrospective cohort study among three US hospitals. BMJ Open. 2022;12(2):e053635. doi: 10.1136/bmjopen-2021-053635
Norsa L, Valle C, Morotti D, Bonaffini PA, Indriolo A, Sonzogni A. Intestinal ischemia in the COVID-19 era. Dig Liver Dis. 2020;52(10):1090-1091. doi: 10.1016/j.dld.2020.05.030
Yazıcıoğlu B, Bakkaloğlu SA; European Society for Pediatric Nephrology. Impact of coronavirus disease-2019 on pediatric nephrology practice and education: an ESPN survey. Pediatr Nephrol. 2022;37(8):1867-1875. doi: 10.1007/s00467-021-05226-1
Gheblawi M, Wang K, Viveiros A, et al. Angiotensin-Converting Enzyme 2: SARS-CoV-2 Receptor and Regulator of the Renin-Angiotensin System: Celebrating the 20th Anniversary of the Discovery of ACE2. Circ Res. 2020;126(10):1456-1474. doi: 10.1161/CIRCRESAHA.120.317015
Aronson JK, Ferner RE. Drugs and the renin-angiotensin system in covid-19. BMJ. 2020;369:m1313. doi: 10.1136/bmj.m1313
Cohen JB, South AM, Shaltout HA, Sinclair MR, Sparks MA. Renin-angiotensin system blockade in the COVID-19 pandemic. Clin Kidney J. 2021;14(1):i48-i59. doi: 10.1093/ckj/sfab026
Najmeddin F, Solhjoo M, Ashraf H, Salehi M, Rasooli F, Ghoghaei M, Soleimani A, Bahreini M. Effects of Renin-Angiotensin-Aldosterone Inhibitors on Early Outcomes of Hypertensive COVID-19 Patients: A Randomized Triple-Blind Clinical Trial. Am J Hypertens. 2021;20;34(11):1217-1226. doi: 10.1093/ajh/hpab111. PMID: 34265044; PMCID: PMC8344947.
Roche JA, Roche R. A hypothesized role for dysregulated bradykinin signaling in COVID-19 respiratory complications. FASEB J. 2020;34(6):7265-7269. doi: 10.1096/fj.202000967
Angeli F, Verdecchia P, Balestrino A, et al. Renin Angiotensin System Blockers and Risk of Mortality in Hypertensive Patients Hospitalized for COVID-19: An Italian Registry. J Cardiovasc Dev Dis. 2022;9(1):15. doi: 10.3390/jcdd9010015
Theodorakopoulou MP, Alexandrou ME, Boutou AK, Ferro CJ, Ortiz A, Sarafidis P. Renin-angiotensin system blockers during the COVID-19 pandemic: an update for patients with hypertension and chronic kidney disease. Clin Kidney J. 2021;15(3):397-406. doi: 10.1093/ckj/sfab272
Jia N, Zhang G, Sun X, et al. Influence of angiotensin converting enzyme inhibitors/angiotensin receptor blockers on the risk of all-cause mortality and other clinical outcomes in patients with confirmed COVID-19: A systemic review and meta-analysis. J Clin Hypertens (Greenwich). 2021;23(9):1651-1663. doi: 10.1111/jch.14329
Kang SH, Lee DH, Han KD, et al. Hypertension, renin-angiotensin-aldosterone-system-blocking agents, and COVID-19. Clin Hypertens. 2021;27(1):11. doi: 10.1186/s40885-021-00168-0
Reyes C, Pistillo A, Fernández-Bertolín S, et al. Characteristics and outcomes of patients with COVID-19 with and without prevalent hypertension: a multinational cohort study. BMJ Open. 2021;11(12):e057632. doi: 10.1136/bmjopen-2021-057632
Safizadeh F, Nguyen TNM, Brenner H, Schöttker B. Association of renin-angiotensin-aldosterone system inhibition with Covid-19 hospitalization and all-cause mortality in the UK biobank. Br J Clin Pharmacol. 2022;88(6):2830-2842. doi: 10.1111/bcp.15192
Lopez-Leon S, Wegman-Ostrosky T, Perelman C, et al. More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. Sci Rep. 2021;11(1):16144. doi: 10.1038/s41598-021-95565-8
Chung EYM, Palmer SC, Natale P, et al. Incidence and Outcomes of COVID-19 in People With CKD: A Systematic Review and Meta-analysis. Am J Kidney Dis. 2021;78(6):804-815. doi: 10.1053/j.ajkd.2021.07.003
Tylicki P, Polewska K, Och A, et al. Angiotensin Converting Enzyme Inhibitors May Increase While Active Vitamin D May Decrease the Risk of Severe Pneumonia in SARS-CoV-2 Infected Patients with Chronic Kidney Disease on Maintenance Hemodialysis. Viruses. 2022;14(3):451. doi: 10.3390/v14030451
Saengsiwaritt W, Jittikoon J, Chaikledkaew U, Udomsinprasert W. Genetic polymorphisms of ACE1, ACE2, and TMPRSS2 associated with COVID-19 severity: A systematic review with meta-analysis. Rev Med Virol. 2022;32(4):e2323. doi: 10.1002/rmv.2323
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 European Journal of Clinical and Experimental Medicine
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our open access policy is in accordance with the Budapest Open Access Initiative (BOAI) definition: this means that articles have free availability on the public Internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from having access to the Internet itself.
All articles are published with free open access under the CC-BY Creative Commons attribution license (the current version is CC-BY, version 4.0). If you submit your paper for publication by the Eur J Clin Exp Med, you agree to have the CC-BY license applied to your work. Under this Open Access license, you, as the author, agree that anyone may download and read the paper for free. In addition, the article may be reused and quoted provided that the original published version is cited. This facilitates freedom in re-use and also ensures that Eur J Clin Exp Med content can be mined without barriers for the research needs.
