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.
[http://dx.doi.org/10.1016/j.pharmthera.2010.06.003] [PMID: 20599443]
[http://dx.doi.org/10.1097/00041433-200210000-00006] [PMID: 12352014]
[http://dx.doi.org/10.1016/j.pharmthera.2008.08.009] [PMID: 18804122]
[http://dx.doi.org/10.1074/jbc.M505111200] [PMID: 15983030]
[http://dx.doi.org/10.1371/journal.pone.0198144] [PMID: 29897923]
[http://dx.doi.org/10.1161/HYPERTENSIONAHA.119.14071] [PMID: 31786979]
[http://dx.doi.org/10.1161/01.HYP.0000244543.91937.79] [PMID: 17000927]
[http://dx.doi.org/10.1016/B978-0-12-385504-6.00001-4] [PMID: 21238933]
[http://dx.doi.org/10.1128/JVI.02202-13] [PMID: 24227843]
[http://dx.doi.org/10.1016/j.fertnstert.2020.04.024] [PMID: 32482249]
[http://dx.doi.org/10.1161/CIRCULATIONAHA.104.510461] [PMID: 15897343]
[http://dx.doi.org/10.1001/jamacardio.2020.1624] [PMID: 32324209]
[http://dx.doi.org/10.1016/j.mayocp.2020.03.026] [PMID: 32376099]
[http://dx.doi.org/10.1111/jch.13917] [PMID: 32643874]