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Potential harmful effects of discontinuing ACE-inhibitors and ARBs in COVID-19 patients.
Elife. 2020 04 06; 9E

Abstract

The discovery of angiotensin converting enzyme-2 (ACE-2) as the receptor for SARS- CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) has implicated the renin-angiotensin-aldosterone system in acute respiratory distress syndrome (ARDS) and respiratory failure in patients with coronavirus disease-19 (COVID-19). The angiotensin converting enzyme-1-angiotensin II-angiotensin AT1 receptor pathway contributes to the pathophysiology of ARDS, whereas activation of the ACE-2-angiotensin(1-7)-angiotensin AT2 receptor and the ACE-2-angiotensin(1-7)-Mas receptor pathways have been shown to be protective. Here we propose and discuss therapeutic considerations how to increase soluble ACE-2 in plasma in order for ACE-2 to capture and thereby inactivate SARS-CoV-2. This could be achieved by administering recombinant soluble ACE-2. We also discuss why and how ACEIs and ARBs provide cardiovascular, renal and also pulmonary protection in SARS-CoV-2- associated ARDS. Discontinuing these medications in COVID-19 patients may therefore potentially be harmful.

Authors+Show Affiliations

Hypertension Unit -Department of Medicine-DIMED, University of Padova, Padova, Italy.International PhD Program in Arterial Hypertension and Vascular Biology (ARHYVAB)- University of Padua, Padua, Italy.University of Zürich, Zürich, Switzerland. Andreas Grüntzig Foundation, Zürich, Switzerland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32250244

Citation

Rossi, Gian Paolo, et al. "Potential Harmful Effects of Discontinuing ACE-inhibitors and ARBs in COVID-19 Patients." ELife, vol. 9, 2020.
Rossi GP, Sanga V, Barton M. Potential harmful effects of discontinuing ACE-inhibitors and ARBs in COVID-19 patients. Elife. 2020;9.
Rossi, G. P., Sanga, V., & Barton, M. (2020). Potential harmful effects of discontinuing ACE-inhibitors and ARBs in COVID-19 patients. ELife, 9. https://doi.org/10.7554/eLife.57278
Rossi GP, Sanga V, Barton M. Potential Harmful Effects of Discontinuing ACE-inhibitors and ARBs in COVID-19 Patients. Elife. 2020 04 6;9 PubMed PMID: 32250244.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Potential harmful effects of discontinuing ACE-inhibitors and ARBs in COVID-19 patients. AU - Rossi,Gian Paolo, AU - Sanga,Viola, AU - Barton,Matthias, Y1 - 2020/04/06/ PY - 2020/03/26/received PY - 2020/04/03/accepted PY - 2020/4/7/pubmed PY - 2020/5/7/medline PY - 2020/4/7/entrez KW - ACE KW - ACE inhibitor KW - ACE inhibitors KW - ACE-2 KW - ACEIs KW - ARBs KW - ARDS KW - Acute respiratory distress syndrome KW - COVID-19 KW - RAAS KW - SARS KW - SARS-CoV-2 KW - angiotensin KW - angiotensin receptor antagonists KW - angiotensin receptor blocker KW - angiotensin-converting enzyme-1 KW - angiotensin-converting enzyme-2 KW - arterial hypertension KW - cardiovascular KW - coronavirus KW - human biology KW - infection KW - medicine KW - renin-angiotensin-aldosterone system KW - therapy KW - treatment KW - virus JF - eLife JO - Elife VL - 9 N2 - The discovery of angiotensin converting enzyme-2 (ACE-2) as the receptor for SARS- CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) has implicated the renin-angiotensin-aldosterone system in acute respiratory distress syndrome (ARDS) and respiratory failure in patients with coronavirus disease-19 (COVID-19). The angiotensin converting enzyme-1-angiotensin II-angiotensin AT1 receptor pathway contributes to the pathophysiology of ARDS, whereas activation of the ACE-2-angiotensin(1-7)-angiotensin AT2 receptor and the ACE-2-angiotensin(1-7)-Mas receptor pathways have been shown to be protective. Here we propose and discuss therapeutic considerations how to increase soluble ACE-2 in plasma in order for ACE-2 to capture and thereby inactivate SARS-CoV-2. This could be achieved by administering recombinant soluble ACE-2. We also discuss why and how ACEIs and ARBs provide cardiovascular, renal and also pulmonary protection in SARS-CoV-2- associated ARDS. Discontinuing these medications in COVID-19 patients may therefore potentially be harmful. SN - 2050-084X UR - https://www.unboundmedicine.com/medline/citation/32250244/Potential_harmful_effects_of_discontinuing_ACE_inhibitors_and_ARBs_in_COVID_19_patients_ DB - PRIME DP - Unbound Medicine ER -