Renin-angiotensin system inhibition in COVID-19 patients

Author(s):
Vries, A.A.F. de
Published
2020
Publication type
Article / Letter to editor

Abstract

Angiotensin-converting enzyme (ACE) inhibitors (ACEIs) and angiotensin II type-1 receptor blockers (ARBs) are among the most widely prescribed drugs for the treatment of arterial hypertension, heart failure and chronic kidney disease. A number of studies, mainly in animals and not involving the lungs, have indicated that these drugs can increase expression of angiotensin-converting enzyme 2 (ACE2). ACE2 is the cell entry receptor of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19) that is currently battering the globe. This has led to the hypothesis that use of ACEIs and ARBs may increase the risk of developing severe COVID-19. In this point of view paper, possible scenarios regarding the impact of ACEI/ARB pharmacotherapy on COVID-19 are discussed in relation to the currently available evidence. Although further research on the influence of blood-pressure-lowering drugs, including those not targeting the renin-angiotensin system, is warranted, there are presently no compelling clinical data showing that ACEIs and ARBs increase the likelihood of contracting COVID-19 or worsen the outcome of SARS-CoV-2 infections. Thus, unless contraindicated, use of ACEIs/ARBs in COVID-19 patients should be continued in line with the recent recommendations of medical societies.

Angiotensin-converting enzymeAngiotensin-converting enzyme inhibitorAngiotensin II type-1 receptor blockerCoronavirus disease 2019Renin-angiotensin systemSevere acute respiratory syndrome coronavirus 2
Date issued
2020-06-08
Language
English
Publisher
BOHN STAFLEU VAN LOGHUM BV
Is part of
Netherlands Heart Journal (2020), Vol. 28, no. 7-8, p. 396-405
hdl
1887/3232738
doi
10.1007/s12471-020-01439-5
URL
https://link.springer.com/article/10.1007/s12471-020-01439-5