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Angiotensin-Converting Enzyme 2 and Antihypertensives (Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors) in Coronavirus Disease 2019.
Mayo Clin Proc. 2020 Jun; 95(6):1222-1230.MC

Abstract

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, is being defined as the worst pandemic disease of modern times. Several professional health organizations have published position papers stating that there is no evidence to change the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in the management of elevated blood pressure in the context of avoiding or treating COVID-19 infection. In this article, we review the evidence on the relationship between the renin-angiotensin-aldosterone system and COVID-19 infection. In agreement with current guidelines, patients with hypertension should continue taking antihypertensive medications as prescribed without interruption. Because ACEIs and ARBs are also used to retard the progression of chronic kidney disease, we suggest that these recommendations also apply to the use of these agents in chronic kidney disease. No differences generally exist between ARBs and ACEIs in terms of efficacy in decreasing blood pressure and improving other outcomes, such as all-cause mortality, cardiovascular mortality, myocardial infarction, heart failure, stroke, and end-stage renal disease. The ACEIs are associated with cough secondary to accumulation of bradykinin and angioedema, and withdrawal rates due to adverse events are lower with ARBs. Given their equal efficacy but fewer adverse events, ARBs could potentially be a more favorable treatment option in patients with COVID-19 at higher risk for severe forms of disease.

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Authors+Show Affiliations

Sanchis-Gomar F
Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Spain; Division of Cardiovascular Medicine, Stanford University School of Medicine, CA. Electronic address: fabian.sanchis@uv.es.
Lavie CJ
John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA.
Perez-Quilis C
Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Spain.
Henry BM
Cardiac Intensive Care Unit, Heart Institute, Cincinnati Children's Hospital Medical Center, OH.
Lippi G
Section of Clinical Biochemistry, University of Verona, Italy.

MeSH

Angiotensin Receptor AntagonistsAngiotensin-Converting Enzyme 2Angiotensin-Converting Enzyme InhibitorsBetacoronavirusCOVID-19ComorbidityCoronavirus InfectionsHumansHypertensionPandemicsPatient SelectionPeptidyl-Dipeptidase APneumonia, ViralRenin-Angiotensin SystemSARS-CoV-2

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

32376099

Clinical Trial Links

Telmisartan in Respiratory Failure Due to COVID-19

Citation

Sanchis-Gomar, Fabian, et al. "Angiotensin-Converting Enzyme 2 and Antihypertensives (Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors) in Coronavirus Disease 2019." Mayo Clinic Proceedings, vol. 95, no. 6, 2020, pp. 1222-1230.
Sanchis-Gomar F, Lavie CJ, Perez-Quilis C, et al. Angiotensin-Converting Enzyme 2 and Antihypertensives (Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors) in Coronavirus Disease 2019. Mayo Clin Proc. 2020;95(6):1222-1230.
Sanchis-Gomar, F., Lavie, C. J., Perez-Quilis, C., Henry, B. M., & Lippi, G. (2020). Angiotensin-Converting Enzyme 2 and Antihypertensives (Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors) in Coronavirus Disease 2019. Mayo Clinic Proceedings, 95(6), 1222-1230. https://doi.org/10.1016/j.mayocp.2020.03.026
Sanchis-Gomar F, et al. Angiotensin-Converting Enzyme 2 and Antihypertensives (Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors) in Coronavirus Disease 2019. Mayo Clin Proc. 2020;95(6):1222-1230. PubMed PMID: 32376099.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Angiotensin-Converting Enzyme 2 and Antihypertensives (Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors) in Coronavirus Disease 2019. AU - Sanchis-Gomar,Fabian, AU - Lavie,Carl J, AU - Perez-Quilis,Carme, AU - Henry,Brandon M, AU - Lippi,Giuseppe, Y1 - 2020/04/04/ PY - 2020/3/26/received PY - 2020/3/27/revised PY - 2020/3/30/accepted PY - 2020/5/8/pubmed PY - 2020/6/17/medline PY - 2020/5/8/entrez SP - 1222 EP - 1230 JF - Mayo Clinic proceedings JO - Mayo Clin Proc VL - 95 IS - 6 N2 - Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, is being defined as the worst pandemic disease of modern times. Several professional health organizations have published position papers stating that there is no evidence to change the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in the management of elevated blood pressure in the context of avoiding or treating COVID-19 infection. In this article, we review the evidence on the relationship between the renin-angiotensin-aldosterone system and COVID-19 infection. In agreement with current guidelines, patients with hypertension should continue taking antihypertensive medications as prescribed without interruption. Because ACEIs and ARBs are also used to retard the progression of chronic kidney disease, we suggest that these recommendations also apply to the use of these agents in chronic kidney disease. No differences generally exist between ARBs and ACEIs in terms of efficacy in decreasing blood pressure and improving other outcomes, such as all-cause mortality, cardiovascular mortality, myocardial infarction, heart failure, stroke, and end-stage renal disease. The ACEIs are associated with cough secondary to accumulation of bradykinin and angioedema, and withdrawal rates due to adverse events are lower with ARBs. Given their equal efficacy but fewer adverse events, ARBs could potentially be a more favorable treatment option in patients with COVID-19 at higher risk for severe forms of disease. SN - 1942-5546 UR - https://www.unboundmedicine.com/medline/citation/32376099/Angiotensin_Converting_Enzyme_2_and_Antihypertensives__Angiotensin_Receptor_Blockers_and_Angiotensin_Converting_Enzyme_Inhibitors__in_Coronavirus_Disease_2019_ DB - PRIME DP - Unbound Medicine ER -