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COVID-19 and RAAS inhibitors: is there a final conclusion?
Mahshid Talebi-Taher1, Mohammad Hosein Najafi2, Shima Behzad2
1Department of Infectious Diseases and Tropical Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Insights
Antihypertensive drugs like ACE inhibitors and ARBs are not linked to increased COVID-19 risk or severity. Current evidence suggests these medications do not negatively impact patient prognosis, though more research is needed.
Area of Science:
- Infectious Diseases
- Cardiology
- Pharmacology
Background:
- Coronavirus disease 2019 (COVID-19) emerged globally in late 2019.
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) utilizes the ACE2 receptor for cell entry.
- Concerns arose regarding the impact of renin-angiotensin-aldosterone system (RAAS) inhibitors, including ACE inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs), on COVID-19 outcomes.
Purpose of the Study:
- To investigate the association between RAAS inhibitor use and COVID-19 patient morbidity and mortality.
- To clarify the role of ACEIs and ARBs in SARS-CoV-2 infection, disease severity, and prognosis.
Main Methods:
- Literature review of existing studies on RAAS inhibitors and COVID-19.
- Analysis of data regarding the influence of ACEIs and ARBs on patient outcomes.
Main Results:
- Data on ACEI/ARB consumption in COVID-19 patients remain scarce and conflicting.
- The most supported theory indicates no association between RAAS inhibitors and increased risk of SARS-CoV-2 infection.
- These medications do not appear to be linked to increased disease severity or poorer patient prognosis.
Conclusions:
- Current evidence suggests that ACE inhibitors and ARBs are not associated with adverse outcomes in COVID-19 patients.
- Further research is necessary to definitively support or refute the hypothesized associations.
- The use of RAAS inhibitors should not be discontinued based on current COVID-19 concerns.
Abstract:
Coronavirus disease 2019 (COVID-19), the first pandemic caused by a human infecting coronavirus, has drawn global attention from the first time it appeared in Wuhan city of China in late December 2019. Detection of the responsible viral pathogen, named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by WHO, and its possible pathogenesis lead to the forming of many hypotheses about the factors that may affect the patients' outcome. One of the SARS-CoV-2 infection concerns was the potential role of angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) in COVID-19 patients' morbidity and mortality. Studies demonstrated that because SARS-CoV-2 uses human ACE2 cell receptors as an entry receptor to invade the cells, there might be an association between antihypertensive drugs such as RAAS inhibitors (specifically ACEIs and ARBs) and the COVID-19 disease. Data are scarce and conflicting regarding ACEI or ARB consumption and how it influences disease outcomes, and a single conclusion has not been reached yet. According to the literature review in our article, the most evidentially supported theory about the use of RAAS inhibitors in COVID-19 is that these medications, including ACEI/ARB, are not associated with the increased risk of infection, disease severity, and patient prognosis. However, further studies are needed to support the hypothesis.
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