Controversial Roles of the Renin Angiotensin System and Its Modulators During the COVID-19 Pandemic

Area of Science:

• Cardiology
• Infectious Diseases
• Pharmacology

Background:

• The COVID-19 pandemic has highlighted the vulnerability of patients with cardiovascular comorbidities.
• These patients often use renin-angiotensin aldosterone system (RAAS)-blockers, raising questions about their safety during SARS-CoV-2 infection.
• The interaction between RAAS-blockers, ACE2, and SARS-CoV-2 pathogenesis is complex and debated.

Purpose of the Study:

• To review the pathophysiological rationale behind the debated role of RAAS and its modulators in COVID-19.
• To summarize available evidence on the impact of RAAS blockers on COVID-19 course and prognosis.
• To emphasize the need for robust data to guide clinical decisions regarding RAAS-interfering drugs.

Main Methods:

• Literature review of the renin-angiotensin aldosterone system (RAAS) and its interaction with SARS-CoV-2.
• Analysis of experimental data on ACE2 expression and RAAS-blocker effects.
• Evaluation of existing evidence on RAAS-blocker use in COVID-19 patients.

Main Results:

• Concerns exist that RAAS-blockers might increase ACE2 expression, potentially facilitating viral entry.
• Conversely, RAAS-blockers may have beneficial effects by modulating the RAAS pathway.
• Retrospective observational studies on this topic require cautious interpretation due to potential biases.

Conclusions:

• The management of RAAS-blockers in COVID-19 patients requires careful consideration of both potential risks and benefits.
• Further high-quality, evidence-based research is crucial to clarify the role of RAAS modulators in SARS-CoV-2 infection.
• Clear guidelines are needed to assist physicians in managing these medications during the pandemic.