Is the use of RAS inhibitors safe in the current era of COVID-19 pandemic?

Sungha Park; Hae Young Lee; Eun Joo Cho; Ki Chul Sung; Juhan Kim; Dae-Hee Kim; Sang-Hyun Ihm; Kwang-Il Kim; Il-Suk Sohn; Wook-Jin Chung; Hyeon Chang Kim; Sung Kee Ryu; Wook Bum Pyun; Jinho Shin; Korean Society of Hypertension

doi:10.1186/s40885-020-00144-0

Is the use of RAS inhibitors safe in the current era of COVID-19 pandemic?

Clin Hypertens. 2020 May 7:26:11. doi: 10.1186/s40885-020-00144-0. eCollection 2020.

Authors

Sungha Park¹, Hae Young Lee², Eun Joo Cho³, Ki Chul Sung⁴, Juhan Kim⁵, Dae-Hee Kim⁶, Sang-Hyun Ihm⁷, Kwang-Il Kim⁸, Il-Suk Sohn⁹, Wook-Jin Chung¹⁰, Hyeon Chang Kim¹¹, Sung Kee Ryu¹², Wook Bum Pyun¹³, Jinho Shin¹⁴; Korean Society of Hypertension

Affiliations

¹ 1Division of Cardiology, Severance Cardiovascular Hospital and Severance Cardiovascular Hospital and Integrated Research Center for Cerebrovascular and Cardiovascular diseases, Yonsei University College of Medicine, Seoul, South Korea.
² 2Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
³ 3Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital., College of Medicine, The Catholic University of Korea, Seoul, South Korea.
⁴ 4Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Seoul, South Korea.
⁵ 5Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea.
⁶ 6Department of Cardiology, Asan Medical Center, College of Medicine, Ulsan University, Seoul, South Korea.
⁷ 7Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital., College of Medicine, The Catholic University of Korea, Seoul, South Korea.
⁸ 8Division of Geriatrics, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
⁹ 9Division of Cardiology, Department of Internal Medicine, Kyung Hee University at Gangdong, Seoul, South Korea.
¹⁰ 10Division of Cardiology, Department of Internal Medicine, Gil Hospital, Gachon University, Incheon, South Korea.
¹¹ 11Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea.
¹² 12Division of Cardiology, Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea.
¹³ 13Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea.
¹⁴ 14Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, 222 Wangsimni-ro Sungdong-gu, Seoul, South Korea.

Abstract

Antihypertensive drugs are one of the most widely used pharmacologic agent in the world and it is predominantly used in the elderly subjects. Pneumonia is the most common cause of death in the extremely old subject. During infection and its complication such as sepsis, hypotension could be exacerbated by antihypertensive drugs because homeostasis mechanisms such as sodium balance, renin angiotensin aldosterone system and/or sympathetic nervous system can be mitigated by antihypertensive drug therapy. Severe Acute Respiratory Syndrome-Coronavirus-1 and 2 viral surface protein is known to attach angiotensin converting enzyme 2 (ACE2) on the cell membrane to facilitate viral entry into the cytoplasm. Despite the theoretical concerns of increased ACE2 expression by Renin-Angiotensin-Aldosterone system (RAS) blockade, there is no evidence that RAS inhibitors are harmful during COVID-19 infection and have in fact been shown to be beneficial in animal studies. Therefore, it is recommended to maintain RAS blockade during the current corona virus pandemic.

Keywords: 2019 novel coronavirus; ACE inhibitor; ACE2; Angiotensin receptor blocker; Antihypertensive drugs; COVID-19; Hypertension; Infection; Pandemic; SARS; SARS-CoV-2; Sepsis.

Publication types

Review