AT1R has a major role in RAS by being involved in several physiological events including blood pressure control and electrolyte balance. Following SARS-CoV-2 infection, pathogenic episodes generated by the vasoconstriction, proinflammatory, profibrotic, and prooxidative consequences of the Ang II–AT1R axis activation are accompanied by a hyperinflammatory state (cytokine storm) and an acute respiratory distress syndrome (ARDS). AT1R, a member of the G protein-coupled receptor (GPCR) family, modulates Ang II deleterious effects through the activation of multiple downstream signaling pathways, among which are MAP kinases (ERK 1/2, JNK, p38MAPK), receptor tyrosine kinases (PDGF, EGFR, insulin receptor), and nonreceptor tyrosine kinases (Src, JAK/STAT, focal adhesion kinase (FAK)), and nicotinamide adenine dinucleotide phosphate (NADPH) oxidase.
Antihypertensive Drugs Used (% of Population) | Period of ARB Intake before COVID-19 Infection | Main Outcomes | References | |
---|---|---|---|---|
ARBs (48%) | ≥7 days after hospital admission | ARB treatment did not worsen clinical outcomes during COVID-19 infection in hypertensive patients. | [24] | [119] |
ARBs (50.6%) | Not mentioned | Previous administration of ARBs had no association with the number of days alive and out of the hospital in mild COVID-19. | [25] | [120] |
ARBs (31.34%) | ≥1 week before the onset of infection | ARB administration, before the onset of infection, significantly lowered the mortality rate in COVID-19 patients. | [26] | [121] |
ARBs (49.3%) | Not mentioned | ARB administration had no effect on the severity and mortality of COVID-19. | [27] | [122] |
ARBs (40.5%) | For >1 y | ARB administration improved clinical outcomes of COVID-19 patients with hypertension. | [28] | [70] |
ARBs (31.8%) | Not mentioned | ARBs were not associated with the severity or mortality of COVID-19 patients with hypertension. | [29] | [123] |
ARB (30.8%) | ≥1 month before hospital admission | ARB administration reduced the risk of death during hospitalization in COVID-19 hypertensive patients. | [24] | [119] |
ARBs (51%) | ≥3 months before study conduction | ARB administration lowered the risk of hospitalization and intubation or death with COVID-19; long-term use of ARBs might decrease the risk of COVID-19 in hypertensive patients. | [30] | [124] |
ARBs (29.7%) | Unknown | Administration of ARBs did not affect the chance of recovery in COVID-19 patients with hypertension or heart failure. | [31] | [125] |
ARBs (17%) | Not mentioned | Previous use of ARBs reduced the risk of mortality in patients hospitalized with COVID-19 infection. | [32] | [126] |