Serum ACE2, Angiotensin II, and Aldosterone Levels Are Unchanged in Patients With COVID-19

Marina Rieder; Luisa Wirth; Luisa Pollmeier; Maren Jeserich; Isabella Goller; Niklas Baldus; Bonaventura Schmid; Hans-Joerg Busch; Maike Hofmann; Winfried Kern; Christoph Bode; Daniel Duerschmied; Achim Lother

doi:10.1093/ajh/hpaa169

Serum ACE2, Angiotensin II, and Aldosterone Levels Are Unchanged in Patients With COVID-19

Am J Hypertens. 2021 Apr 2;34(3):278-281. doi: 10.1093/ajh/hpaa169.

Authors

Marina Rieder^{1

2}, Luisa Wirth³, Luisa Pollmeier³, Maren Jeserich^{1

2}, Isabella Goller^{1

2}, Niklas Baldus^{1

2}, Bonaventura Schmid⁴, Hans-Joerg Busch⁴, Maike Hofmann⁵, Winfried Kern⁶, Christoph Bode^{1

2}, Daniel Duerschmied^{1

2}, Achim Lother^{1

2

3}

Affiliations

¹ Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
² Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
³ Institute of Experimental and Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
⁴ Department of Emergency Medicine, University Hospital of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
⁵ Medical Center-University of Freiburg, Department of Medicine II, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
⁶ Medical Center-University of Freiburg, Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, University of Freiburg, Freiburg, Germany.

Abstract

Background: The role of the renin-angiotensin-aldosterone system (RAAS) in coronavirus disease 2019 (COVID-19) is controversially discussed. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters host cells by binding to angiotensin-converting enzyme 2 (ACE2) and activity of the RAAS may affect susceptibility to SARS-CoV-2 infection and outcome of patients with COVID-19.

Methods: In this prospective single-center study, we determined the serum levels of ACE2, angiotensin II, and aldosterone in patients with COVID-19 compared with control patients presenting with similar symptoms in the emergency unit.

Results: We analyzed serum samples from 24 SARS-CoV-2 positive and 61 SARS-CoV-2 negative patients. SARS-CoV-2 positive and control patients did not differ in baseline patients characteristics, symptoms, and clinical presentation. Mean serum concentrations of ACE2, angiotensin II, and aldosterone did not differ between the SARS-CoV-2 positive and the control group. In line with this, serum potassium as surrogate parameter for RAAS activity and blood pressure were similar in both groups.

Conclusions: In summary, we did not find evidence for altered RAAS activity including angiotensin II, aldosterone, or potassium levels, and blood pressure in patients with COVID-19.

Clinical trials registration: Trial Number DRKS00021206.

Keywords: ACE2; COVID-19; SARS-CoV-2; aldosterone; angiotensin II; blood pressure; hypertension.

Publication types

Clinical Study
Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Aldosterone / blood*
Angiotensin II / blood*
Angiotensin-Converting Enzyme 2 / blood*
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Blood Pressure Determination / statistics & numerical data
COVID-19* / blood
COVID-19* / diagnosis
COVID-19* / epidemiology
COVID-19* / physiopathology
Female
Germany / epidemiology
Humans
Hypertension* / blood
Hypertension* / drug therapy
Hypertension* / epidemiology
Hypertension* / physiopathology
Male
Middle Aged
Outcome Assessment, Health Care
Potassium / blood*
Prospective Studies
Renin-Angiotensin System / physiology
SARS-CoV-2 / isolation & purification

Substances

Angiotensin-Converting Enzyme Inhibitors
Angiotensin II
Aldosterone
Angiotensin-Converting Enzyme 2
Potassium