Response to “COVID-19 and ACEI/ARB: Not Associated?”
Notice bibliographique
Résumé
To the Editor: Hajra and Bandyopadhyay in a letter to the Editor1 comment on our recent Editorial on Hypertension and Coronavirus Disease 2019 (COVID-19),2 and endorse what we have said in it, updating some even more recent findings. Since our Editorial was written a little more than a month ago, the pandemic has grown further with 3,775,667 confirmed infected cases worldwide and 264,406 deaths, and 1,228,609 persons with confirmed infections in the United States with 73,431 deaths as of 7 May 2020.3 Hajra and Bandyopadhyay mention angiotensin converting enzyme 2 (ACE2), the receptor for the novel coronavirus severe acute respiratory syndrome (SARS)-CoV-2, in the lung where the virus may bind to enter cells and produce pulmonary injury. ACE2 is in fact widely distributed, and was recently demonstrated in nasal epithelial goblet/secretory cells and in nasal epithelial ciliated cells, in corneal cells in the eye, and in esophagus and intestinal epithelial cells4 as well as in oral mucosa cells,5 which are probably ways whereby the virus enters the body and proliferates to eventually infect the lower respiratory tract and the lung. These findings may explain the respiratory transmission as well as the potential for fecal–oral transmission. Hajra and Bandyopadhyay have cited recent retrospective studies6,7 that were published after our Editorial in the last month that support our conclusion that there is no evidence of harm of angiotensin converting enzyme inhibitors and angiotensin receptor blockers in patients with COVID-19. A population-based case–control study in the Lombardy region of Italy evaluated a total of 6,272 case patients in who SARS-CoV-2 was confirmed between 21 February and 11 March 2020.8 These were matched to 30,759 beneficiaries of the Regional Health Service (controls) according to sex, age, and residence. In this large, population-based study, there was no evidence that angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers affected the risk of COVID-19. As well, among a total of 18,472 patients tested for COVID-19 in the Cleveland Clinic Health System in Ohio and Florida between 8 March and 12 April 2020, there was no association of use of ACE inhibitors and angiotensin receptor blockers with testing positive for COVID-19,9 which suggests that taking these agents did not increase susceptibility to infection by the novel virus RAS-CoV-2. Hajra and Bandyopadhyay mention that “COVID-19 is a new threat for all health care providers, but would like (us) to highlight the future of these widely used antihypertensives in the setting of this newly emerging infection.” As we have indicated in our Editorial, use of ACE inhibitors and angiotensin receptor blockers should be maintained for the control of blood pressure and treatment of other cardiovascular conditions for which they are used. Randomized controlled trials of both initiation and replacement of renin–angiotensin system inhibitors would be necessary to answer in a definitive way the question of whether these agents are harmful, beneficial, or neutral in patients with COVID-19. In the meantime, these drugs should certainly not be discontinued, at least on the basis of the most current and recent retrospective evidence, in agreement with recommendations of different national and international societies and organizations.10 As well, to the best of our knowledge, there is no reason to avoid the initiation of renin–angiotensin system blockers in any patient subgroup unless there are specific contraindications unrelated to COVID-19. The authors declared no conflict of interest.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,022 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,002 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,007 | 0,003 |
| Communication savante | 0,005 | 0,003 |
| Science ouverte | 0,002 | 0,003 |
| Intégrité de la recherche | 0,081 | 0,046 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,016 | 0,010 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».