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Coronavirus Disease 2019 and Hypertension: The Role of Angiotensin-Converting
Enzyme 2 and the Renin-Angiotensin System
#MMPMID33308506
Edmonston DL
; South AM
; Sparks MA
; Cohen JB
Adv Chronic Kidney Dis
2020[Sep]; 27
(5
): 404-411
PMID33308506
show ga
Hypertension emerged from early reports as a potential risk factor for worse
outcomes for persons with coronavirus disease 2019 (COVID-19). Among the putative
links between hypertension and COVID-19 is a key counter-regulatory component of
the renin-angiotensin system (RAS): angiotensin-converting enzyme 2 (ACE2). ACE2
facilitates entry of severe acute respiratory syndrome coronavirus 2, the virus
responsible for COVID-19, into host cells. Because RAS inhibitors have been
suggested to increase ACE2 expression, health-care providers and patients have
grappled with the decision of whether to discontinue these medications during the
COVID-19 pandemic. However, experimental models of analogous viral pneumonias
suggest RAS inhibitors may exert protective effects against acute lung injury. We
review how RAS and ACE2 biology may affect outcomes in COVID-19 through pulmonary
and other systemic effects. In addition, we briefly detail the data for and
against continuation of RAS inhibitors in persons with COVID-19 and summarize the
current consensus recommendations from select specialty organizations.
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