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Renin-angiotensin system inhibitors in COVID-19

George Thomas1

  • 1Department of Nephrology and Hypertension, Cleveland Clinic.

Cleveland Clinic Journal of Medicine
|May 16, 2020
PubMed

Insights

Current evidence does not suggest discontinuing renin-angiotensin system (RAS) inhibitors for patients with COVID-19. These drugs do not appear to increase SARS-CoV-2 infection risk or worsen outcomes, even if they affect ACE2 expression.

Area of Science:

  • Cardiovascular Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Concerns exist regarding renin-angiotensin system (RAS) inhibitors potentially increasing angiotensin-converting enzyme 2 (ACE2) expression.
  • This upregulation might theoretically enhance severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) entry and COVID-19 severity.

Purpose of the Study:

  • To evaluate the clinical evidence regarding RAS inhibitors, ACE2 expression, and SARS-CoV-2 infection risk.
  • To provide guidance on the use of RAS inhibitors in patients with COVID-19.

Main Methods:

  • Review of current clinical evidence and scientific literature.
  • Analysis of the relationship between RAS inhibitors, ACE2 modulation, and viral susceptibility.

Main Results:

  • No current evidence indicates that RAS inhibitors increase the risk of SARS-CoV-2 infection.
  • No clinical data suggest that RAS inhibitors worsen outcomes in patients with COVID-19, despite potential ACE2 effects.
  • Discontinuation of RAS inhibitors is not recommended for stable COVID-19 patients.

Conclusions:

  • RAS inhibitors can generally be continued in stable patients with COVID-19.
  • Treatment decisions for hospitalized severe COVID-19 patients on RAS inhibitors should be individualized based on clinical status, including hemodynamics and renal function.

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