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COVID-19 and renin-angiotensin system modulators: what do we know so far?

Angel de la Cruz1, Shoaib Ashraf1, Timothy J Vittorio2,3

  • 1Department of Internal Medicine, BronxCare Health System Bronx, NY, USA.

Expert Review of Cardiovascular Therapy
|August 27, 2020
PubMed

Insights

Physicians should continue renin-angiotensin system (RAS) inhibitors, such as ACE-inhibitors and ARBs, for patients with cardiovascular disease and COVID-19. Expert guidelines advise against altering these essential treatments based on clinical status.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Pharmacology

Background:

  • COVID-19, caused by SARS-CoV-2, poses a global health challenge.
  • Hypertension and cardiovascular disease increase COVID-19 mortality risk.
  • SARS-CoV-2 utilizes ACE2 for cell entry, raising concerns about RAS modulators.

Purpose of the Study:

  • To review literature on the association between RAS inhibitors and severe COVID-19.
  • To determine the appropriateness of continuing ACE-inhibitors and ARBs in active COVID-19 cases.

Main Methods:

  • Literature review of studies on RAS inhibitors (ACE-inhibitors, ARBs) and COVID-19 severity.
  • Analysis of recommendations regarding medication continuation in infected patients.

Main Results:

  • Concerns exist regarding RAS antagonists potentially increasing COVID-19 severity due to ACE2 upregulation.
  • Evidence synthesis to inform clinical decision-making.

Conclusions:

  • Major cardiology societies recommend against initiating or withdrawing RAS inhibitors for COVID-19 patients with cardiovascular disease.
  • Treatment decisions for ACE-inhibitors/ARBs should be individualized based on patient presentation and hemodynamics.
Abstract

Keywords:
Angiotensin-converting enzymeCovid-19coronavirusrenin-angiotensin systemsevere acute respiratory syndrome coronavirus 2

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