{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T04:07:42Z","timestamp":1777522062963,"version":"3.51.4"},"reference-count":54,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,12,6]],"date-time":"2020-12-06T00:00:00Z","timestamp":1607212800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern Med"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>COVID\u201019 is caused by the coronavirus SARS\u2010CoV\u20102, which uses angiotensin\u2010converting enzyme 2 (ACE\u20102) as a receptor for cellular entry. It is theorized that ACE inhibitors (ACE\u2010Is) or angiotensin receptor blockers (ARBs) may increase vulnerability to SARS\u2010CoV\u20102 by upregulating ACE\u20102 expression, but ACE\u2010I\/ARB discontinuation is associated with clinical deterioration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine whether ACE\u2010I and ARB use is associated with acute kidney injury (AKI), macrovascular thrombosis and in\u2010hospital mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective, single\u2010centre study of 558 hospital inpatients with confirmed COVID\u201019 admitted from 1 March to 30 April 2020, followed up until 24 May 2020. AKI and macrovascular thrombosis were primary end\u2010points, and in\u2010hospital mortality was a secondary end\u2010point.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>AKI occurred in 126 (23.1%) patients, 34 (6.1%) developed macrovascular thrombi, and 200 (35.9%) died. Overlap propensity score\u2010weighted analysis showed no significant effect of ACE\u2010I\/ARB use on the risk of occurrence of the specified end\u2010points. On exploratory analysis, severe chronic kidney disease (CKD) increases odds of macrovascular thrombi (OR: 8.237, 95% CI: 1.689\u201340.181, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.009). The risk of AKI increased with advancing age (OR: 1.028, 95% CI: 1.011\u20131.044, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.001) and diabetes (OR: 1.675, 95% CI: 1.065\u20132.633, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.025). Immunosuppression was associated with lower risk of AKI (OR: 0.160, 95% CI: 0.029\u20130.886, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.036). Advancing age, dependence on care, male gender and eGFR\u00a0&lt;\u00a060\u00a0mL\u00a0min<jats:sup>\u22121<\/jats:sup>\/1.73\u00a0m<jats:sup>2<\/jats:sup> increased odds of in\u2010hospital mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We did not identify an association between ACE\u2010I\/ARB use and AKI, macrovascular thrombi or mortality. This supports the recommendations of the European and American Societies of Cardiology that ACE\u2010Is and ARBs should not be discontinued during the COVID\u201019 pandemic.<\/jats:p><\/jats:sec>","DOI":"10.1111\/joim.13202","type":"journal-article","created":{"date-parts":[[2020,11,19]],"date-time":"2020-11-19T02:48:35Z","timestamp":1605754115000},"page":"688-699","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["ACE inhibitors, angiotensin receptor blockers and endothelial injury in COVID\u201019"],"prefix":"10.1111","volume":"289","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3110-1125","authenticated-orcid":false,"given":"S.","family":"Tetlow","sequence":"first","affiliation":[{"name":"From the Department of Acute Medicine University College Hospital Bloomsbury London 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