{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T18:18:23Z","timestamp":1761157103616,"version":"3.41.2"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T00:00:00Z","timestamp":1614816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003286","name":"Kuwait Foundation for the Advancement of Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003286","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p><jats:bold>Introduction:<\/jats:bold> Corona Virus disease 2019 (COVID-19) caused by the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) has become a global pandemic. The aim of this study was to investigate the impact of being on an Angiotensin-Converting Enzyme Inhibitors (ACEI) and\/or Angiotensin Receptor Blockers (ARB) on hospital admission, on the following COVID-19 outcomes: disease severity, ICU admission, and mortality.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> The charts of all patients consecutively diagnosed with COVID-19 from the 24th of February to the 16th of June of the year 2020 in Jaber Al-Ahmed Al-Sabah hospital in Kuwait were checked. All related patient information and clinical data was retrieved from the hospitals electronic medical record system. The primary outcome was COVID-19 disease severity defined as the need for Intensive Care Unit (ICU) admission. Secondary outcome was mortality.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> A total of 4,019 COVID-19 patients were included, of which 325 patients (8.1%) used ACEI\/ARB, users of ACEI\/ARB were found to be significantly older (54.4 vs. 40.5 years). ACEI\/ARB users were found to have more co-morbidities; diabetes (45.8 vs. 14.8%) and hypertension (92.9 vs. 13.0%). ACEI\/ARB use was found to be significantly associated with greater risk of ICU admission in the unadjusted analysis [OR, 1.51 (95% CI: 1.04\u20132.19), <jats:italic>p<\/jats:italic> = 0.028]. After adjustment for age, gender, nationality, coronary artery disease, diabetes and hypertension, ICU admission was found to be inversely associated with ACEI use [OR, 0.57 (95% CI: 0.34\u20130.88), <jats:italic>p<\/jats:italic> = 0.01] and inversely associated with mortality [OR, 0.56 (95% CI: 0.33\u20130.95), <jats:italic>p<\/jats:italic> = 0.032].<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> The current evidence in the literature supports continuation of ACEI\/ARB medications for patients with co-morbidities that acquire COVID-19 infection. Although, the protective effects of such medications on COVID-19 disease severity and mortality remain unclear, the findings of the present study support the use of ACEI\/ARB medication.<\/jats:p>","DOI":"10.3389\/fmed.2021.600385","type":"journal-article","created":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T04:48:02Z","timestamp":1614833282000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Angiotensin-Converting Enzyme (ACE) Inhibitors and Angiotensin Receptor Blockers (ARB) Are Protective Against ICU Admission and Mortality for Patients With COVID-19 Disease"],"prefix":"10.3389","volume":"8","author":[{"given":"Rawan","family":"ElAbd","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dana","family":"AlTarrah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"AlYouha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hamad","family":"Bastaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sulaiman","family":"Almazeedi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohannad","family":"Al-Haddad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad","family":"Jamal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salman","family":"AlSabah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,3,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"157","DOI":"10.23750\/abm.v91i1.9397","article-title":"WHO declares COVID-19 a pandemic","volume":"91","author":"Cucinotta","year":"2020","journal-title":"Acta Biomed."},{"key":"B2","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1016\/j.kint.2020.03.005","article-title":"Kidney disease is associated with in-hospital death of patients with COVID-19","volume":"97","author":"Cheng","year":"2020","journal-title":"Kidney Int."},{"key":"B3","doi-asserted-by":"publisher","first-page":"100","DOI":"10.3760\/cma.j.issn.1007-3418.2020.02.002","article-title":"[Exploring the mechanism of liver enzyme abnormalities in patients with novel coronavirus-infected pneumonia]","volume":"28","author":"Guan","year":"2020","journal-title":"Zhonghua Gan Zang Bing Za Zhi."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1001\/jama.2020.1585","article-title":"Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China","volume":"323","author":"Wang","year":"2020","journal-title":"JAMA."},{"key":"B5","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China","volume":"395","author":"Huang","year":"2020","journal-title":"Lancet."},{"key":"B6","first-page":"E1","article-title":"Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in china: summary of a report of 72 314 cases from the Chinese center for disease control and prevention","volume-title":"JAMA.","author":"Wu","year":"2020"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1054","DOI":"10.1016\/S0140-6736(20)30566-3","article-title":"Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study","volume":"395","author":"Zhou","year":"2020","journal-title":"Lancet."},{"key":"B8","doi-asserted-by":"publisher","first-page":"4","DOI":"10.3390\/v12040372","article-title":"Virology, epidemiology, pathogenesis, and control of COVID-19","volume":"12","author":"Jin","year":"2020","journal-title":"Viruses."},{"key":"B9","first-page":"145","volume-title":"The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) in China. Zhonghualiuxingbingxuezazhi","author":"Team","year":"2020"},{"key":"B10","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1038\/s41586-020-2012-7","article-title":"A pneumonia outbreak associated with a new coronavirus of probable bat origin","volume":"579","author":"Zhou","year":"2020","journal-title":"Nature."},{"key":"B11","doi-asserted-by":"publisher","first-page":"E1","DOI":"10.1161\/01.RES.87.5.e1","article-title":"A novel angiotensin-converting enzyme-related carboxypeptidase (ACE2) converts angiotensin I to angiotensin 1-9","volume":"87","author":"Donoghue","year":"2000","journal-title":"Circ Res."},{"key":"B12","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1007\/s11684-020-0754-0","article-title":"Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection","volume":"14","author":"Zou","year":"2020","journal-title":"Front Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"2605","DOI":"10.1161\/CIRCULATIONAHA.104.510461","article-title":"Effect of angiotensin-converting enzyme inhibition and angiotensin II receptor blockers on cardiac angiotensin-converting enzyme 2","volume":"111","author":"Ferrario","year":"2005","journal-title":"Circulation."},{"key":"B14","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1042\/BJ20040634","article-title":"Evaluation of angiotensin-converting enzyme (ACE), its homologue ACE2 and neprilysin in angiotensin peptide metabolism","volume":"383","author":"Rice","year":"2004","journal-title":"Biochem J."},{"volume-title":"Clinical Management of Severe Acute Respiratory Infection When Novel Coronavirus (nCoV) Infection Is Suspected","year":"2020","key":"B15"},{"key":"B16","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1016\/j.cca.2020.04.023","article-title":"Highly sensitive detection of SARS-CoV-2 RNA by multiplex rRT-PCR for molecular diagnosis of COVID-19 by clinical laboratories","volume":"507","author":"Ishige","year":"2020","journal-title":"Clin Chim Acta."},{"volume-title":"R: A Language and Environment for Statistical Computing","year":"2020","key":"B17"},{"key":"B18","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1093\/jtm\/taaa041","article-title":"Hypothesis: angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may increase the risk of severe COVID-19","volume":"27","author":"Diaz","year":"2020","journal-title":"J Travel Med."},{"key":"B19","doi-asserted-by":"publisher","first-page":"781","DOI":"10.1097\/HJH.0000000000002450","article-title":"Can angiotensin receptor-blocking drugs perhaps be harmful in the COVID-19 pandemic?","volume":"38","author":"Esler","year":"2020","journal-title":"J Hypertens."},{"key":"B20","doi-asserted-by":"publisher","first-page":"e21","DOI":"10.1016\/S2213-2600(20)30116-8","article-title":"Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?","volume":"8","author":"Fang","year":"2020","journal-title":"Lancet Respir Med."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1653","DOI":"10.1056\/NEJMsr2005760","article-title":"Renin-Angiotensin-aldosterone system inhibitors in patients with Covid-19","volume":"382","author":"Vaduganathan","year":"2020","journal-title":"N Engl J Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1042\/CS20120162","article-title":"Combination renin-angiotensin system blockade and angiotensin-converting enzyme 2 in experimental myocardial infarction: implications for future therapeutic directions","volume":"123","author":"Burchill","year":"2012","journal-title":"Clin Sci (Lond)."},{"key":"B23","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1002\/path.1570","article-title":"Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis","volume":"203","author":"Hamming","year":"2004","journal-title":"J Pathol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1001\/jama.2020.11301","article-title":"Association of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use with COVID-19 diagnosis and mortality","volume":"324","author":"Fosb\u00f8l","year":"2020","journal-title":"JAMA."},{"key":"B25","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1016\/j.omtm.2020.06.017","article-title":"The two faces of ACE2: the role of ACE2 receptor and its polymorphisms in hypertension and COVID-19","volume":"18","author":"Bosso","year":"2020","journal-title":"Mol Ther Methods Clin Dev."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1138","DOI":"10.1161\/HYPERTENSIONAHA.113.01274","article-title":"Angiotensin-(1-7)","volume":"63","author":"Santos","year":"2014","journal-title":"Hypertension."},{"key":"B27","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1038\/nature03712","article-title":"Angiotensin-converting enzyme 2 protects from severe acute lung failure","volume":"436","author":"Imai","year":"2005","journal-title":"Nature."},{"key":"B28","doi-asserted-by":"publisher","first-page":"822","DOI":"10.1038\/nature00786","article-title":"Angiotensin-converting enzyme 2 is an essential regulator of heart function","volume":"417","author":"Crackower","year":"2002","journal-title":"Nature."},{"key":"B29","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1001\/jamacardio.2020.1624","article-title":"Association of Renin-Angiotensin system inhibitors with severity or risk of death in patients with hypertension hospitalized for coronavirus disease 2019 (COVID-19) Infection in Wuhan, China","volume":"5","author":"Li","year":"2020","journal-title":"JAMA Cardiol."},{"key":"B30","first-page":"8","article-title":"ACE-inhibitors, angiotensin receptor blockers and endothelial injury in COVID-19","volume-title":"J Intern Med.","author":"Tetlow","year":"2020"},{"key":"B31","doi-asserted-by":"publisher","first-page":"100660","DOI":"10.1016\/j.ijcha.2020.100660","article-title":"The influence of ACE inhibitors and ARBs on hospital length of stay and survival in people with COVID-19","volume":"31","author":"Braude","year":"2020","journal-title":"Int J Cardiol Heart Vasc."},{"key":"B32","doi-asserted-by":"publisher","first-page":"1671","DOI":"10.1161\/CIRCRESAHA.120.317242","article-title":"Association of inpatient use of angiotensin-converting enzyme inhibitors and angiotensin ii receptor blockers with mortality among patients with hypertension hospitalized with COVID-19","volume":"126","author":"Zhang","year":"2020","journal-title":"Circ Res."},{"key":"B33","doi-asserted-by":"publisher","first-page":"1384","DOI":"10.1186\/s12889-020-09490-y","article-title":"COVID-19 clinical outcomes and nationality: results from a Nationwide registry in Kuwait","volume":"20","author":"Hamadah","year":"2020","journal-title":"BMC Public Health."},{"key":"B34","doi-asserted-by":"publisher","first-page":"21","DOI":"10.14744\/AnatolJCardiol.2020.57431","article-title":"Association between chronic ACE inhibitor exposure and decreased odds of severe disease in patients with COVID-19","volume":"24","author":"Senkal","year":"2020","journal-title":"Anatol J Cardiol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"e15","DOI":"10.1161\/HYPERTENSIONAHA.120.15622","article-title":"Comparative impacts of ACE (Angiotensin-Converting Enzyme) inhibitors versus angiotensin ii receptor blockers on the risk of COVID-19 mortality","volume":"76","author":"Zhou","year":"2020","journal-title":"Hypertension."},{"key":"B36","doi-asserted-by":"publisher","first-page":"967","DOI":"10.1002\/ejhf.1924","article-title":"Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers are not associated with severe COVID-19 infection in a multi-site UK acute hospital trust","volume":"22","author":"Bean","year":"2020","journal-title":"Eur J Heart Fail."},{"key":"B37","doi-asserted-by":"publisher","first-page":"104927","DOI":"10.1016\/j.phrs.2020.104927","article-title":"ACEI\/ARB use and risk of infection or severity or mortality of COVID-19: A systematic review and meta-analysis","volume":"158","author":"Zhang","year":"2020","journal-title":"Pharmacol Res."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1519","DOI":"10.1136\/heartjnl-2020-317336","article-title":"Treatment with ACE inhibitors or ARBs and risk of severe\/lethal COVID-19: a meta-analysis","volume":"106","author":"Flacco","year":"2020","journal-title":"Heart."},{"key":"B39","unstructured":"Position Statement of the ESC Council on Hypertension on ACE-Inhibitors and Angiotensin Receptor Blockers2020"},{"key":"B40","doi-asserted-by":"publisher","first-page":"2441","DOI":"10.1056\/NEJMoa2008975","article-title":"Renin-Angiotensin-Aldosterone System Inhibitors and Risk of Covid-19","volume":"382","author":"Reynolds","year":"2020","journal-title":"N Engl J Med."},{"key":"B41","doi-asserted-by":"publisher","first-page":"1505","DOI":"10.1007\/s00109-020-01981-0","article-title":"ACE polymorphisms and COVID-19-related mortality in Europe","volume":"98","author":"Bellone","year":"2020","journal-title":"J Mol Med (Berl)."},{"key":"B42","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1093\/ehjcvp\/pvaa056","article-title":"Continuation versus discontinuation of ACE inhibitors or angiotensin II receptor blockers in COVID-19: effects on blood pressure control and mortality","volume":"6","author":"Cannata","year":"2020","journal-title":"Eur Heart J Cardiovasc Pharmacother."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.600385\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T04:48:12Z","timestamp":1614833292000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.600385\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,4]]},"references-count":42,"alternative-id":["10.3389\/fmed.2021.600385"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2021.600385","relation":{},"ISSN":["2296-858X"],"issn-type":[{"type":"electronic","value":"2296-858X"}],"subject":[],"published":{"date-parts":[[2021,3,4]]},"article-number":"600385"}}