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Renin-Angiotensin-Aldosterone System Inhibitors in COVID-19: A Review
Filipe Ferrari1, Vítor Magnus Martins2, Flávio Danni Fuchs1,3
1Programa de Pos-Graduacao em Cardiologia e Ciencias Cardiovasculares, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR.
Clinics (Sao Paulo, Brazil)
|April 14, 2021
Summary
Early concerns suggested renin-angiotensin-aldosterone system (RAAS) inhibitors worsened COVID-19 outcomes. However, extensive research, including observational studies and a randomized trial, found no consistent link between RAAS inhibitors and poor prognosis in COVID-19 patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- Initial reports suggested a link between renin-angiotensin-aldosterone system (RAAS) inhibitors and poor COVID-19 prognosis.
- Concerns arose regarding potential mechanisms, such as blocking angiotensin-converting enzyme 2 (ACE2), impacting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outcomes.
- Potential confounding factors, like underlying cardiovascular diseases, may have influenced early observations.
Purpose of the Study:
- To investigate the association between RAAS inhibitor use and prognosis in patients with COVID-19.
- To clarify the safety and efficacy of continuing RAAS inhibitors during the COVID-19 pandemic.
Main Methods:
- Analysis of observational studies and a randomized clinical trial involving COVID-19 patients.
- Evaluation of clinical data to assess the relationship between RAAS inhibitor use and disease outcomes.
Main Results:
- Multiple studies, including large cohorts and a randomized trial, did not find a consistent association between RAAS inhibitors and unfavorable COVID-19 prognosis.
- Evidence suggests that the initial concerns were not supported by larger, more robust clinical data.
Conclusions:
- Current clinical evidence indicates that RAAS inhibitors do not worsen COVID-19 prognosis.
- Leading scientific societies recommend continuing RAAS inhibitor therapy in COVID-19 patients unless clinically contraindicated.
- Clinicians and patients should adhere to these recommendations based on accumulated evidence.
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