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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.
Hypertension. 2020 06; 75(6):1382-1385.H

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.

Authors+Show Affiliations

From the Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands (A.H.J.D.).Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, FL (M.E.).Division of Nephrology/Hypertension, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (D.B.).

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

32208987

Citation

Danser, A H Jan, et al. "Renin-Angiotensin System Blockers and the COVID-19 Pandemic: at Present There Is No Evidence to Abandon Renin-Angiotensin System Blockers." Hypertension (Dallas, Tex. : 1979), vol. 75, no. 6, 2020, pp. 1382-1385.
Danser AHJ, Epstein M, Batlle D. Renin-Angiotensin System Blockers and the COVID-19 Pandemic: At Present There Is No Evidence to Abandon Renin-Angiotensin System Blockers. Hypertension. 2020;75(6):1382-1385.
Danser, A. H. J., Epstein, M., & Batlle, D. (2020). Renin-Angiotensin System Blockers and the COVID-19 Pandemic: At Present There Is No Evidence to Abandon Renin-Angiotensin System Blockers. Hypertension (Dallas, Tex. : 1979), 75(6), 1382-1385. https://doi.org/10.1161/HYPERTENSIONAHA.120.15082
Danser AHJ, Epstein M, Batlle D. Renin-Angiotensin System Blockers and the COVID-19 Pandemic: at Present There Is No Evidence to Abandon Renin-Angiotensin System Blockers. Hypertension. 2020;75(6):1382-1385. PubMed PMID: 32208987.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Renin-Angiotensin System Blockers and the COVID-19 Pandemic: At Present There Is No Evidence to Abandon Renin-Angiotensin System Blockers. AU - Danser,A H Jan, AU - Epstein,Murray, AU - Batlle,Daniel, Y1 - 2020/03/25/ PY - 2020/3/27/pubmed PY - 2020/5/19/medline PY - 2020/3/27/entrez KW - ACE inhibitor KW - COVID-19 KW - angiotensin receptor blocker KW - coronavirus KW - severe acute respiratory syndrome SP - 1382 EP - 1385 JF - Hypertension (Dallas, Tex. : 1979) JO - Hypertension VL - 75 IS - 6 N2 - 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. SN - 1524-4563 UR - https://www.unboundmedicine.com/medline/citation/32208987/Renin_Angiotensin_System_Blockers_and_the_COVID_19_Pandemic:_At_Present_There_Is_No_Evidence_to_Abandon_Renin_Angiotensin_System_Blockers_ L2 - http://www.ahajournals.org/doi/full/10.1161/HYPERTENSIONAHA.120.15082?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -