Lack of benefit of renin-angiotensin system inhibitors in COVID-19

Abstract

There has been considerable interest in the potential role of renin-angiotensin system (RAS) inhibitors in patients with COVID-19 given that angiotensin-converting enzyme 2 (ACE2) is the functional receptor for SARS-CoV-2. Because ACE inhibitors and angiotensin receptor blockers (ARBs) may upregulate ACE2, there is a theoretical concern that these agents might increase susceptibility to, or the severity of, SARS-CoV-2 infection. Conversely, ACE2 is the primary enzyme breaking down angiotensin II and, in the process, produces angiotensin 1-7, a physiological antagonist of angiotensin II. SARS-CoV-2 downregulates ACE2, potentially leading to an increase in angiotensin II and reduced levels of angiotensin 1-7. Excess and unopposed angiotensin II may be harmful, and in experimental models of lung injury, administration of RAS inhibitors, ACE2, and angiotensin 1-7 reduced pulmonary damage and mortality. Consequently, there has been uncertainty about the place of RAS inhibitors in patients with COVID-19.

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DOI

https://doi.org/10.1001/jama.2023.4405

Repository URI

https://eprints.gla.ac.uk/296872/