The Effect of Antihypertensive Drugs on the Serum Level of Angiotensin-Converting Enzyme 2 (ACE2) in Hypertensive Patients with Severe COVID-19 Infection

Although many studies were conducted worldwide on the effect of angiotensin converting enzyme inhibition on the morbidity and mortality of the patients with COVID-19, these studies have varied in their conclusions due to differences in populations, races, and ethnicity. This work aimed to study the effect of different antihypertensive drugs on the serum level of angiotensin-converting enzyme-2 in severely infected COVID-19 patients with hypertension. This study was conducted in Al-Nahrain University/College of Medicine/Chemistry and Biochemistry Department and Al-Mustansyria University /College of Medicine / Department of Medicine, Baghdad, Iraq. The study included 50 patients with confirmed severe COVID-19 infection: 25 COVID-19 patients with hypertension administered to the hospital, and 25 COVID-19 patients without hypertension administered to the hospital during the period from January, 2022 to September, 2022. The hypertensive patients were on angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) or Calcium-channel blockers or beta blockers prior to COVID-19 infection. The median level of angiotensin converting enzyme-2 (ACE2) in hypertensive patients was 3.22ng/ml (range 1.34-6.89 ng/ml) compared with0.89 ng/ml (range 0.22-1.35 ng/ml) in non-hypertensive group, with a highly significant difference. The study also showed a significantly higher level of serum ACE2 in patients on ACE inhibitors (median= 4.85 ng/ml, range= 3.22-6.89 ng/ml) than either of hypertensive patients taking ARBs (median= 2.56 ng/ml, range= 2.27-4.34 ng/ml) or those on Ca-channel blockers (median= 2.43 ng/ml, range= 1.34-4.39 ng/ml) with significant differences. It was also observed that patients on ARBs displayed the lowest concentration of D-dimer. This study showed that the use of antihypertensive drugs (ACE inhibitors or ARBs or Ca-channel blockers) prior to the infection with COVID-19 was not associated with the severity of disease and therefore, should not be discontinued during the course of infection.