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Coronavirus Disease 2019 and Hypertension: The Role of Angiotensin-Converting Enzyme 2 and the Renin-Angiotensin

Daniel L Edmonston1, Andrew M South2, Matthew A Sparks3

  • 1Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Renal Section, Durham VA Health Care System, Durham, NC.

Advances in Chronic Kidney Disease
|December 14, 2020
PubMed

Insights

Hypertension is linked to severe COVID-19 outcomes. Renin-angiotensin system (RAS) inhibitors may offer protection against lung injury, despite concerns about ACE2 expression.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Pulmonology

Background:

  • Hypertension is a significant risk factor for severe COVID-19 outcomes.
  • The renin-angiotensin system (RAS) and its enzyme, angiotensin-converting enzyme 2 (ACE2), play a role in COVID-19 pathogenesis.
  • ACE2 facilitates the entry of SARS-CoV-2 into host cells.

Purpose of the Study:

  • To review the complex interplay between RAS, ACE2, and COVID-19 outcomes.
  • To evaluate the potential benefits and risks of continuing RAS inhibitors during the COVID-19 pandemic.
  • To summarize current recommendations regarding RAS inhibitor use in COVID-19 patients.

Main Methods:

  • Literature review of studies on hypertension, COVID-19, and the renin-angiotensin system.
  • Analysis of experimental models of viral pneumonias and RAS inhibitors.
  • Synthesis of clinical data and expert consensus on RAS inhibitor management.

Main Results:

  • RAS inhibitors may have protective effects against acute lung injury in viral pneumonias.
  • Concerns exist that RAS inhibitors might increase ACE2 expression, potentially aiding viral entry.
  • Data on RAS inhibitor continuation in COVID-19 patients is complex and evolving.

Conclusions:

  • The role of RAS and ACE2 in COVID-19 requires further investigation.
  • RAS inhibitors may offer benefits in managing COVID-19, particularly regarding lung injury.
  • Current consensus recommendations guide healthcare providers in managing these medications during the pandemic.

Keywords:
Angiotensin receptor blockerAngiotensin-converting enzyme 2Angiotensin-converting enzyme inhibitorCOVID-19CoronavirusRenin-angiotensin system

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