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) may up-regulate ACE2
expression that is used as 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 unlike to be harmful in COVID-19-positive patients.
Conclusions: Further randomized trials are needed to answer definitely the question of whether RAS inhibitors are
harmful or beneficial to patients with COVID-19.