Response to “COVID-19 and ACEI/ARB: Not Associated?”
Bibliographic record
Abstract
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.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.022 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.007 | 0.003 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.081 | 0.046 |
| Insufficient payload (model declined to judge) | 0.016 | 0.010 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".