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Renin-Angiotensin System Blockers and the COVID-19 Pandemic: At Present There Is No Evidence to Abandon Renin-Angiotensin System Blockers.
Danser, A H Jan; Epstein, Murray; Batlle, Daniel.
  • Danser AHJ; From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands (A.H.J.D.).
  • Epstein M; Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, FL (M.E.).
  • Batlle D; Division of Nephrology/Hypertension, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (D.B.).
Hypertension ; 75(6): 1382-1385, 2020 06.
Article in English | MEDLINE | ID: covidwho-15781
ABSTRACT
During the spread of the severe acute respiratory syndrome coronavirus-2, some reports of data still emerging and in need of full analysis indicate that certain groups of patients are at risk of COVID-19. This includes patients with hypertension, heart disease, diabetes mellitus, and clearly the elderly. Many of those patients are treated with renin-angiotensin system blockers. Because the ACE2 (angiotensin-converting enzyme 2) protein is the receptor that facilitates coronavirus entry into cells, the notion has been popularized that treatment with renin-angiotensin system blockers might increase the risk of developing a severe and fatal severe acute respiratory syndrome coronavirus-2 infection. The present article discusses this concept. ACE2 in its full-length form is a membrane-bound enzyme, whereas its shorter (soluble) form circulates in blood at very low levels. As a mono-carboxypeptidase, ACE2 contributes to the degradation of several substrates including angiotensins I and II. ACE (angiotensin-converting enzyme) inhibitors do not inhibit ACE2 because ACE and ACE2 are different enzymes. Although angiotensin II type 1 receptor blockers have been shown to upregulate ACE2 in experimental animals, the evidence is not always consistent and differs among the diverse angiotensin II type 1 receptor blockers and differing organs. Moreover, there are no data to support the notion that ACE inhibitor or angiotensin II type 1 receptor blocker administration facilitates coronavirus entry by increasing ACE2 expression in either animals or humans. Indeed, animal data support elevated ACE2 expression as conferring potential protective pulmonary and cardiovascular effects. In summary, based on the currently available evidence, treatment with renin-angiotensin system blockers should not be discontinued because of concerns with coronavirus infection.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Receptors, Virus / Renin-Angiotensin System / Angiotensin-Converting Enzyme Inhibitors / Coronavirus Infections / Peptidyl-Dipeptidase A / Angiotensin II Type 1 Receptor Blockers / Betacoronavirus Type of study: Experimental Studies / Prognostic study / Randomized controlled trials Limits: Animals / Humans Language: English Journal: Hypertension Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Receptors, Virus / Renin-Angiotensin System / Angiotensin-Converting Enzyme Inhibitors / Coronavirus Infections / Peptidyl-Dipeptidase A / Angiotensin II Type 1 Receptor Blockers / Betacoronavirus Type of study: Experimental Studies / Prognostic study / Randomized controlled trials Limits: Animals / Humans Language: English Journal: Hypertension Year: 2020 Document Type: Article