Coronavirus disease 2019, hypertension, and renin–angiotensin–aldosterone system inhibitors. (11th September 2022)

• Record Type: Journal Article
• Authors: Rizk, John G.; Sanchis-Gomar, Fabian; Henry, Brandon M.; Lippi, Giuseppe; Lavie, Carl J.
• Is Part Of: Current opinion in cardiology. Volume 37:Number 5(2022)
• Page Start: 419
• Page End: 423
• Publication Date: 2022-09-11
• Subjects: coronavirus disease 2019 -- hypertension -- pharmacotherapy -- renin–angiotensin–aldosterone system inhibitor; Cardiology -- Periodicals; Cardiology -- Periodicals; Heart Diseases -- Periodicals; Cardiology; Periodicals; 616.12
• DOI: 10.1097/HCO.0000000000000982
• Languages: English
• ISSNs: 0268-4705

Abstract

Abstract : Purpose of review: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mostly uses the angiotensin-converting enzyme 2 (ACE-2) as cellular receptor for entering the host cells. Some, but not all, animal studies have shown that renin–angiotensin–aldosterone system (RAAS) inhibitors can increase ACE-2 expression. On that premise, it was hypothesized that these agents could make it more likely to develop coronavirus disease 2019 (COVID-19). On the other hand, there was also evidence that being on these agents could lessen the severity of the lung injury in patients with severe SARS-CoV-2 infection. Herein, we review the available evidence on the role of RAAS inhibitors on SARS-CoV-2 and COVID-19 development. Recent findings: Recent randomized controlled trials demonstrate that RAAS blockade or withdrawal does not influence the severity of COVID-19 in patients who are already on these medications. Currently, there is no evidence to support stopping RAAS inhibitors in patients hospitalized for COVID-19. Several questions still need to be addressed. Ongoing studies are currently evaluating the de novo use of RAAS inhibitors in patients with COVID-19. Another area that needs to be investigated is whether or not using these medications increase the risk of infection. Summary: The wealth of evidence indicates that ACE inhibitors and angiotensin-receptor blocker administration has no harmful effects on hospitalizations and severity of COVID-19 in patients already on these medications and might even reduce mortality among hypertensive patients diagnosed with COVID-19. More evidence and data need to be collected, and at this time, these agents should not be discontinued.