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ACE2 (Angiotensin-Converting Enzyme 2), COVID-19, and ACE Inhibitor and Ang II (Angiotensin II) Receptor Blocker Use During the Pandemic: The Pediatric Perspective.
Hypertension. 2020 Jul; 76(1):16-22.H

Abstract

Potential but unconfirmed risk factors for coronavirus disease 2019 (COVID-19) in adults and children may include hypertension, cardiovascular disease, and chronic kidney disease, as well as the medications commonly prescribed for these conditions, ACE (angiotensin-converting enzyme) inhibitors, and Ang II (angiotensin II) receptor blockers. Coronavirus binding to ACE2 (angiotensin-converting enzyme 2), a crucial component of the renin-angiotensin-aldosterone system, underlies much of this concern. Children are uniquely impacted by the coronavirus, but the reasons are unclear. This review will highlight the relationship of COVID-19 with hypertension, use of ACE inhibitors and Ang II receptor blockers, and lifetime risk of cardiovascular disease from the pediatric perspective. We briefly summarize the renin-angiotensin-aldosterone system and comprehensively review the literature pertaining to the ACE 2/Ang-(1-7) pathway in children and the clinical evidence for how ACE inhibitors and Ang II receptor blockers affect this important pathway. Given the importance of the ACE 2/Ang-(1-7) pathway and the potential differences between adults and children, it is crucial that children are included in coronavirus-related research, as this may shed light on potential mechanisms for why children are at decreased risk of severe COVID-19.

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Authors+Show Affiliations

South AM
From the Section of Nephrology, Department of Pediatrics, Wake Forest School of Medicine and Brenner Children's Hospital (A.M.S.). Department of Surgery-Hypertension and Vascular Research (A.M.S.), Wake Forest School of Medicine, Winston Salem, NC. Division of Public Health Sciences, Department of Epidemiology and Prevention (A.M.S.), Wake Forest School of Medicine, Winston Salem, NC. Cardiovascular Sciences Center (A.M.S.), Wake Forest School of Medicine, Winston Salem, NC.
Brady TM
Division of Nephrology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD (T.M.B.).
Flynn JT
Department of Pediatrics, University of Washington School of Medicine and Division of Nephrology, Seattle Children's Hospital (J.T.F.).

MeSH

Angiotensin Receptor AntagonistsAngiotensin-Converting Enzyme 2Angiotensin-Converting Enzyme InhibitorsBetacoronavirusCOVID-19ChildComorbidityCoronavirus InfectionsHumansHypertensionPandemicsPeptidyl-Dipeptidase APneumonia, ViralRenin-Angiotensin SystemSARS-CoV-2

Pub Type(s)

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

Language

eng

PubMed ID

32367746

Citation

South, Andrew M., et al. "ACE2 (Angiotensin-Converting Enzyme 2), COVID-19, and ACE Inhibitor and Ang II (Angiotensin II) Receptor Blocker Use During the Pandemic: the Pediatric Perspective." Hypertension (Dallas, Tex. : 1979), vol. 76, no. 1, 2020, pp. 16-22.
South AM, Brady TM, Flynn JT. ACE2 (Angiotensin-Converting Enzyme 2), COVID-19, and ACE Inhibitor and Ang II (Angiotensin II) Receptor Blocker Use During the Pandemic: The Pediatric Perspective. Hypertension. 2020;76(1):16-22.
South, A. M., Brady, T. M., & Flynn, J. T. (2020). ACE2 (Angiotensin-Converting Enzyme 2), COVID-19, and ACE Inhibitor and Ang II (Angiotensin II) Receptor Blocker Use During the Pandemic: The Pediatric Perspective. Hypertension (Dallas, Tex. : 1979), 76(1), 16-22. https://doi.org/10.1161/HYPERTENSIONAHA.120.15291
South AM, Brady TM, Flynn JT. ACE2 (Angiotensin-Converting Enzyme 2), COVID-19, and ACE Inhibitor and Ang II (Angiotensin II) Receptor Blocker Use During the Pandemic: the Pediatric Perspective. Hypertension. 2020;76(1):16-22. PubMed PMID: 32367746.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - ACE2 (Angiotensin-Converting Enzyme 2), COVID-19, and ACE Inhibitor and Ang II (Angiotensin II) Receptor Blocker Use During the Pandemic: The Pediatric Perspective. AU - South,Andrew M, AU - Brady,Tammy M, AU - Flynn,Joseph T, Y1 - 2020/05/05/ PY - 2020/5/6/pubmed PY - 2020/6/23/medline PY - 2020/5/6/entrez SP - 16 EP - 22 JF - Hypertension (Dallas, Tex. : 1979) JO - Hypertension VL - 76 IS - 1 N2 - Potential but unconfirmed risk factors for coronavirus disease 2019 (COVID-19) in adults and children may include hypertension, cardiovascular disease, and chronic kidney disease, as well as the medications commonly prescribed for these conditions, ACE (angiotensin-converting enzyme) inhibitors, and Ang II (angiotensin II) receptor blockers. Coronavirus binding to ACE2 (angiotensin-converting enzyme 2), a crucial component of the renin-angiotensin-aldosterone system, underlies much of this concern. Children are uniquely impacted by the coronavirus, but the reasons are unclear. This review will highlight the relationship of COVID-19 with hypertension, use of ACE inhibitors and Ang II receptor blockers, and lifetime risk of cardiovascular disease from the pediatric perspective. We briefly summarize the renin-angiotensin-aldosterone system and comprehensively review the literature pertaining to the ACE 2/Ang-(1-7) pathway in children and the clinical evidence for how ACE inhibitors and Ang II receptor blockers affect this important pathway. Given the importance of the ACE 2/Ang-(1-7) pathway and the potential differences between adults and children, it is crucial that children are included in coronavirus-related research, as this may shed light on potential mechanisms for why children are at decreased risk of severe COVID-19. SN - 1524-4563 UR - https://www.unboundmedicine.com/medline/citation/32367746/ACE2__Angiotensin_Converting_Enzyme_2__COVID_19_and_ACE_Inhibitor_and_Ang_II__Angiotensin_II__Receptor_Blocker_Use_During_the_Pandemic:_The_Pediatric_Perspective_ DB - PRIME DP - Unbound Medicine ER -