Article ; Online: Outcomes in Patients with COVID-19 Infection Taking ACEI/ARB.
2020 Volume 22, Issue 5, Page(s) 31
Abstract: Purpose of review: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus responsible for the aggressive coronavirus disease (COVID-19) pandemic. Recently, investigators have stipulated that COVID-19 patients receiving angiotensin- ... ...
| Abstract | Purpose of review: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus responsible for the aggressive coronavirus disease (COVID-19) pandemic. Recently, investigators have stipulated that COVID-19 patients receiving angiotensin-converting-enzyme inhibitors (ACEI) may be subject to poorer outcomes. This editorial presents the available evidence to guide treatment practices during this pandemic. Recent findings: Recent studies from Wuhan cohorts provide valuable information about COVID-19. A cohort with 52 critically ill patients revealed cardiac injury in 12% of patients. Worse outcomes appear to be more prevalent in patients with hypertension and diabetes mellitus (DM), possibly due to overexpression of angiotensin-converting enzyme 2 (ACE2) receptor in airway alveolar epithelial cells. Investigators suspect that SARS-CoV-2 uses the ACE2 receptor to enter the lungs in a mechanism similar to SARS-CoV. Several hypotheses have been proposed to date regarding the net effect of ACEI/ARB on COVID-19 infections. Positive effects include ACE2 receptor blockade, disabling viral entry into the heart and lungs, and an overall decrease in inflammation secondary to ACEI/ARB. Negative effects include a possible retrograde feedback mechanism, by which ACE2 receptors are upregulated. Even though physiological models of SARS-CoV infection show a theoretical benefit of ACEI/ARB, these findings cannot be extrapolated to SARS-CoV-2 causing COVID-19. Major cardiology scientific associations, including ACC, HFSA, AHA, and ESC Hypertension Council, have rejected these correlation hypotheses. After an extensive literature review, we conclude that there is no significant evidence to support an association for now, but given the rapid evolvement of this pandemic, findings may change. |
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| MeSH term(s) | Alveolar Epithelial Cells/metabolism ; Angiotensin Receptor Antagonists/adverse effects ; Angiotensin Receptor Antagonists/therapeutic use ; Angiotensin-Converting Enzyme 2 ; Angiotensin-Converting Enzyme Inhibitors/adverse effects ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Betacoronavirus ; COVID-19 ; Comorbidity ; Coronavirus/drug effects ; Coronavirus/isolation & purification ; Coronavirus Infections/drug therapy ; Coronavirus Infections/epidemiology ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/epidemiology ; Humans ; Hypertension/complications ; Hypertension/epidemiology ; Pandemics ; Peptidyl-Dipeptidase A/adverse effects ; Peptidyl-Dipeptidase A/therapeutic use ; Pneumonia, Viral/drug therapy ; Pneumonia, Viral/epidemiology ; Practice Guidelines as Topic ; SARS-CoV-2 |
| Chemical Substances | Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors ; Peptidyl-Dipeptidase A (EC 3.4.15.1) ; ACE2 protein, human (EC 3.4.17.23) ; Angiotensin-Converting Enzyme 2 (EC 3.4.17.23) |
| Keywords | covid19 |
| Language | English |
| Publishing date | 2020-04-14 |
| Publishing country | United States |
| Document type | Journal Article ; Review |
| ZDB-ID | 2055373-0 |
| ISSN | 1534-3170 ; 1523-3782 |
| ISSN (online) | 1534-3170 |
| ISSN | 1523-3782 |
| DOI | 10.1007/s11886-020-01291-4 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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