Potential harmful effects of discontinuing ACE-inhibitors and ARBs in COVID-19 patients.
Level V
Where this comes from
- Record sourced from PubMed, PMID 32250244.
- Also identified by DOI 10.7554/eLife.57278 and PMC identifier 7198232.
- Licence recorded as CC BY.
- The licence permits redistribution, so the abstract is shown in full and the full text is available from the publisher.
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 AT<sub>1</sub> receptor pathway contributes to the pathophysiology of ARDS, whereas activation of the ACE-2-angiotensin(1-7)-angiotensin AT<sub>2</sub> 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.
Medical subject headings
- Angiotensin Receptor Antagonists
- Angiotensin-Converting Enzyme Inhibitors
- Coronavirus Infections
- Peptidyl-Dipeptidase A
- Pneumonia, Viral