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Renin-angiotensin system blockade in the COVID-19 pandemic

Jordana B Cohen1,2, Andrew M South3,4,5,6, Hossam A Shaltout5,6,7,8

  • 1Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

Clinical Kidney Journal
|April 2, 2021
PubMed

Insights

Early COVID-19 theories suggested renin-angiotensin system (RAS) inhibitors worsened outcomes. However, evidence suggests RAS blockade may be protective against severe COVID-19, warranting further research.

Area of Science:

  • Cardiovascular Physiology
  • Infectious Disease Epidemiology
  • Pharmacology

Background:

  • Early COVID-19 pandemic theories linked renin-angiotensin system (RAS) inhibitors to increased disease severity.
  • This hypothesis stemmed from angiotensin-converting enzyme 2 (ACE2) acting as the SARS-CoV-2 binding site.
  • Concerns arose that RAS blockade might upregulate ACE2, potentially increasing COVID-19 risk.

Purpose of the Study:

  • To review classic RAS physiology and the role of ACE2 in COVID-19.
  • To critically evaluate evidence on RAS blockade interactions with COVID-19.
  • To examine recent trial data and suggest future research directions.

Main Methods:

  • Literature review of RAS physiology.
  • Analysis of ACE2 function in systemic pathways impacted by COVID-19.
  • Critical appraisal of physiologic and epidemiologic data.
  • Review of recent clinical trial evidence.

Main Results:

  • The study provides an overview of RAS physiology and ACE2's role.
  • It critically reviews evidence on RAS blockade and COVID-19 severity.
  • Recent trial data is examined to inform understanding.

Conclusions:

  • Counterarguments suggested potential protective effects of ACE2 and RAS blockade in acute lung injury.
  • Discontinuing RAS inhibitors carries substantial risks.
  • Further research is needed to clarify the complex relationship between RAS blockade and COVID-19 outcomes.
Keywords:
COVID-19SARS-CoV-2angiotensin II receptor blockerangiotensin-converting enzyme 2angiotensin-converting enzyme inhibitorcoronavirushypertensionrenin–angiotensin system

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