Continue renin-angiotensin blockers during COVID-19 crisis


  • Heather Mason
  • Univadis Medical News
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A review published in Hypertension concludes that there is no current evidence to warrant abandoning renin-angiotensin system (RAS) blockers in the COVID-19 crisis.

Hypertension, coronary heart disease, and diabetes mellitus, particularly in the elderly, are known to increase susceptibility to COVID-19 infection, many of whom will be treated with RAS blockers and angiotensin-converting enzyme (ACE) inhibitors.

Confusion arose in the medical profession when it was announced that the cellular entry mechanism of coronavirus is facilitated by the angiotensin-converting enzyme 2 (ACE2) protein. Many have asked whether renin-angiotensin system blockers and ACE inhibitors are safe to use in the current COVID-19 crisis.

ACE inhibitors are confused with ACE2 inhibitors. ACE and ACE2 are different enzymes and therefore, ACE inhibitors do not inhibit ACE2. This is unlikely to have any relationship with COVID-19 binding. ACE2 contributes to the degradation of angiotensins I and II.

Angiotensin receptor blockers (ARBs) are suggested to alter ACE2 expression in animals, yet the evidence is diverse and requires high doses.

There is no data to support the theory that ACE inhibitors or angiotensin II type I receptor blockers facilitate coronavirus entry; in fact, animal studies have shown potentially protective pulmonary and cardiovascular effects of elevated ACE2 expression, the authors say.