Important Steps to Control COVID-19/SARS-CoV-2 Infection

Area of Science:

• Virology and Geriatric Medicine
• Cardiovascular Pharmacology

Background:

• Elderly individuals exhibit elevated mortality rates from COVID-19 (Coronavirus Disease 2019) caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2).
• The SARS-CoV-2 virus utilizes the angiotensin-converting enzyme 2 (ACE2) receptor for cellular entry.
• Commonly prescribed Angiotensin Receptor Blockers (ARBs) and Angiotensin-Converting Enzyme Inhibitors (ACEIs) in elderly patients are associated with increased ACE2 expression.

Purpose of the Study:

• To investigate the potential impact of ARBs/ACEIs on COVID-19 severity in elderly patients.
• To propose therapeutic strategies for mitigating COVID-19 severity in this vulnerable population.

Main Methods:

• Review of existing literature on SARS-CoV-2, ACE2 receptor function, and the effects of ARBs/ACEIs.
• Analysis of the association between ACE2 overexpression and COVID-19 outcomes.
• Consideration of alternative drug classes for managing hypertension in elderly patients during the pandemic.

Main Results:

• Overexpression of ACE2 due to ARB/ACEI use may exacerbate SARS-CoV-2 infection.
• Switching to drug classes not affecting ACE2 levels could reduce COVID-19 severity.

Conclusions:

• Temporary discontinuation or switching of ARBs/ACEIs to alternative antihypertensive medications is recommended for elderly patients during SARS-CoV-2 infection.
• Specific human immunoglobulins may be considered as an adjunctive therapy for critically ill COVID-19 patients under medical supervision.