Is the use of RAS inhibitors safe in the current era of COVID-19 pandemic?

Abstract

Antihypertensive drugs are one of the most widely used pharmacologic agent in the world and it is predominantly used in the elderly subjects. Pneumonia is the most common cause of death in the extremely old subject. During infection and its complication such as sepsis, hypotension could be exacerbated by antihypertensive drugs because homeostasis mechanisms such as sodium balance, renin angiotensin aldosterone system and/or sympathetic nervous system can be mitigated by antihypertensive drug therapy. Severe Acute Respiratory Syndrome-Coronavirus-1 and 2 viral surface protein is known to attach angiotensin converting enzyme 2 (ACE2) on the cell membrane to facilitate viral entry into the cytoplasm. Despite the theoretical concerns of increased ACE2 expression by Renin-Angiotensin-Aldosterone system (RAS) blockade, there is no evidence that RAS inhibitors are harmful during COVID-19 infection and have in fact been shown to be beneficial in animal studies. Therefore, it is recommended to maintain RAS blockade during the current corona virus pandemic. Park S received honoraria from Dai ichi Sankyo, Servier, Takeda, Boryung pharmaceutical company, Daewoong and Dong-A ST. HY Lee received honoraria from Dai ichi Sankyo, Servier, Takeda, Boryung Pharm., Daewoong, and Dong-A ST; DH Kim received honoraria from Sankyo, Servier, Takeda, Boryung Pharm., Daewoong, and Dong-ST; IS Sohn received grants from Hanmi. Pharm. and honoraria form Sankyo, Boryung, and Dong-A ST; WJ Chung received honoraria from Norvatis, Servier, Dong-A ST, Takeda, Boryung, and Hanmi Pharm.; J Shin received grants from Hanmi Pharm. and Sanifi and honoraria from Sankyo, Boryung, and Menarini. EJ Cho, KC Sung, J Kim, SH Ihm, K Kim, SK Ryu, WB Pyun, and HC Kim have no conflicts of interest.

Use of distinct anti‐hypertensive drugs and risk for COVID‐19 among hypertensive people: A population‐based cohort study in Southern Catalonia, Spain

“…Other anti‐hypertensive (diuretics, beta‐blockers, and calcium channel blockers) or cardiovascular medications (oral anticoagulant, antiplatelet, and statins) did not significantly alter COVID‐19 infection risk in community‐dwelling and/or nursing home residents with hypertension. Data support maintaining RAAS inhibitors (even prioritizing them) to treat hypertensive patients in the current era of COVID‐19 global pandemic, as experts and scientific societies have recommended 25,26,27,28 …”

The associations between fasting plasma glucose levels and mortality of COVID-19 in patients without diabetes

“…The possible cause might be that these disorders share underlying pathophysiology related to the renin-angiotensin system (RAS). Activity of the angiotensin-converting enzyme 2 (ACE2) is dysregulated in cardiovascular disease, and this enzyme is used by SARS-CoV-2 to initiate the infection [11]. Besides, the patients with chronic pulmonary diseases also have higher mortality.…”

ACE2 in the Era of SARS-CoV-2: Controversies and Novel Perspectives

“…Hence, following the SARS-CoV-2 outbreak, it has been speculated that the use of ACEI and ARB could increase viral invasion and should therefore be temporarily suspended. This topic has been abundantly debated in the last few months (March-May 2020), with contradictory views (Bavishi et al, 2020;Buckley et al, 2020;Danser et al, 2020;Fang et al, 2020;Huang Z. et al, 2020;Kreutz et al, 2020;Kuster et al, 2020;Mourad and Levy, 2020;Park et al, 2020;Rico-Mesa et al, 2020;Sommerstein et al, 2020;South et al, 2020;Tignanelli et al, 2020;Vaduganathan et al, 2020;Verdecchia et al, 2020b;Zhang P. et al, 2020). As a consequence of this debate, several clinical societies have stated that suspension of ACEI and ARB is not justified on the basis of the present scientific evidence, although a recent BMJ editorial (Aronson and Ferner, 2020) suggested to consider stopping ACE inhibitors or angiotensin receptor blockers in patients with mild hypertension who are at high risk of coronavirus infection.…”