- Despite some evidence of up-regulation of ACE2 by RAAS inhibition, with its theoretically associated higher susceptibility to COVID-19 infection and increased viral load, there is currently no data suggesting a causal relationship between ACE2 activity and COVID-19 associated mortality; therefore, based on currently available data, the assumption of a causal relationship between ACE-I or ARB and deleterious outcome in COVID-19 is unfounded.
- In patients with heart failure, hypertension, or myocardial infarction, ACE-I and ARB therapy should be maintained/initiated according to current guidelines, irrespective of COVID-19.
These statements are based on a literature review published in the European Heart Journal of the European Society of Cardiology (ESC) on March 20, in response to recent emerging concerns over the safety of these drugs in COVID-19 patients. Also included in the sources is another litterature review, published more recently in AHA Hypertension, which covers the same topic and comes to the same conclusions.
- Kuster G., Pfister O., Burkard T., Zhou Q., Twerenbold R., Haaf P., Widmer A., Osswald S. (March 20, 2020). SARS-CoV2: should inhibitors of the renin–angiotensin system be withdrawn in patients with COVID-19? European Heart Journal. https://doi.org/10.1093/eurheartj/ehaa235
- Jan Danser A.H., Epstein M., Batlle D. (March 25, 2020). Renin-Angiotensin System Blockers and the COVID-19 Pandemic: At Present There Is No Evidence to Abandon Renin-Angiotensin System Blockers. AHA Hypertension. https://doi.org/10.1161/HYPERTENSIONAHA.120.15082