Renin–Angiotensin–Aldosterone System Inhibitors in Covid-19

ABSTRACT

To the Editor In their Special Report, Vaduganathan and colleagues (April 23 issue)1 describe the use of renin–angiotensin–aldosterone system (RAAS) inhibitors in patients with coronavirus disease 2019 (Covid-19). We would like to add the following points. First, it is worthwhile noting that studies involving in vitro human and animal cell cultures have shown that the effector peptide product of angiotensin-converting enzyme 2 (ACE2), angiotensin-(1–7), is degraded by the dipeptidase ACE into angiotensin-(1–5), and ACE inhibitors increase circulating levels of angiotensin-(1–7) in patients with chronic heart failure.2 This action provides a plausible mechanism for the increase in levels of angiotensin-(1–7) mediated . . .