Clinical Implications of SARS-CoV-2 Interaction With Renin Angiotensin System: JACC Review Topic of the Week

Agnieszka Brojakowska, Jagat Narula, Rony Shimony, Jeffrey Bander

Research output: Contribution to journalReview articlepeer-review

102 Scopus citations

Abstract

Severe acute respiratory-syndrome coronavirus-2 (SARS-CoV-2) host cell infection is mediated by binding to angiotensin-converting enzyme 2 (ACE2). Systemic dysregulation observed in SARS-CoV was previously postulated to be due to ACE2/angiotensin 1-7 (Ang1-7)/Mas axis downregulation; increased ACE2 activity was shown to mediate disease protection. Because angiotensin II receptor blockers, ACE inhibitors, and mineralocorticoid receptor antagonists increase ACE2 receptor expression, it has been tacitly believed that the use of these agents may facilitate viral disease; thus, they should not be used in high-risk patients with cardiovascular disease. Based on the anti-inflammatory benefits of the upregulation of the ACE2/Ang1-7/Mas axis and previously demonstrated benefits of lung function improvement in SARS-CoV infections, it has been hypothesized that the benefits of treatment with renin-angiotensin system inhibitors in SARS-CoV-2 may outweigh the risks and at the very least should not be withheld.

Original languageEnglish
Pages (from-to)3085-3095
Number of pages11
JournalJournal of the American College of Cardiology
Volume75
Issue number24
DOIs
StatePublished - 23 Jun 2020

Keywords

  • ACE inhibitor
  • COVID-19
  • SARS-CoV-2
  • angiotensin II receptor blockers
  • angiotensin-converting enzyme-2
  • mineralocorticoid receptor antagonist

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