Title:COVID-19, Angiotensin-Converting Enzyme 2 and Renin-Angiotensin System
Inhibition: Implications for Practice
Volume: 18
Issue: 1
Author(s): Vasiliki Katsi, George Pavlidis*, George Charalambous, Dimitrios Tousoulis and Konstantinos Toutouzas
Affiliation:
- Emergency Department, ‘Hippokration’ General Hospital, Athens, Greece
Keywords:
COVID-19, hypertension, angiotensin-converting enzyme 2, renin-angiotensin system, an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker.
Abstract:
Background: Recent studies suggested that patients with coronavirus disease 2019
(COVID-19) who use renin-angiotensin system (RAS) inhibitors have an increased risk of respiratory
failure and death. The hypothesis was that angiotensin-converting enzyme inhibitor (ACEIs)
or angiotensin receptor blocker (ARBs) might up-regulate ACE2 expression that is used as a receptor
for viral entry into cells.
Objective: The purpose of this review is to discuss the existing evidence on the interaction between
COVID-19 infection, ACE2 and ACEIs or ARBs and to examine the main implications for clinical
practice. In addition, novel therapeutic strategies for blocking ACE2-mediated COVID-19 infection
will be displayed.
Methods: We performed a comprehensive review of the literature to identify data from clinical and
experimental studies for the association between COVID-19 infection, ACE2 and RAS inhibition.
Results: The current clinical and experimental evidence for ACEIs or ARBs to facilitate severe
acute respiratory distress syndrome-coronavirus-2 (SARS-CoV-2) is insufficient to suggest discontinuing
these drugs. Several observational studies arrive at the conclusion that the continued use of
RAS inhibitors is unlikely to be harmful in COVID-19-positive patients.
Conclusions: Further randomized trials are needed to answer the question of whether RAS inhibitors
are harmful or beneficial to patients with COVID-19.