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Should we continue to use renin-angiotensin-aldosterone system blockers in patients with COVID-19?

Sidar Copur1, Asiye Kanbay2, Mehmet Kanbay3

  • 1Department of Medicine, Koc University School of Medicine, Istanbul, Turkey.

Clinical Kidney Journal
|May 2, 2022
PubMed

Insights

Patients with chronic kidney disease, heart failure, and hypertension at high risk for COVID-19 death should continue renin-angiotensin-aldosterone system (RAS) blockers. Discontinuation does not improve outcomes and may worsen underlying conditions.

Area of Science:

  • Cardiovascular Medicine
  • Infectious Diseases
  • Nephrology

Background:

  • Patients with chronic kidney disease, heart failure, and hypertension face elevated risks of mortality from COVID-19.
  • Renin-angiotensin-aldosterone system (RAS) blockers are standard treatments for these conditions, aiming to reduce morbidity and mortality.
  • The COVID-19 pandemic raised concerns regarding RAS blocker use due to the virus's entry mechanism via angiotensin-converting enzyme-2.

Discussion:

  • This review examines the pathophysiology linking RAS blockers and COVID-19.
  • It synthesizes evidence from observational studies and clinical trials addressing the use of RAS blockers in COVID-19 patients.
  • The ongoing scientific debate regarding RAS blockers and COVID-19 is highlighted.

Key Insights:

  • Discontinuation of RAS blockers in COVID-19 patients is not associated with improved clinical outcomes.
  • Stopping RAS blockers may lead to adverse effects, including the exacerbation of pre-existing conditions like heart failure and kidney disease.
  • The evidence does not support withholding RAS blockers in patients with these comorbidities during COVID-19 infection.

Outlook:

  • Further research is warranted to fully elucidate the complex interactions between RAS blockers, COVID-19, and patient outcomes.
  • Clinical guidelines should be informed by robust evidence to ensure optimal management of patients with cardiovascular and kidney diseases during viral pandemics.
  • Maintaining established therapies like RAS blockers is crucial for managing chronic conditions, even in the context of novel infectious diseases.

Keywords:
COVID-19chronic kidney diseasehypertensionrenin angiotensin system

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