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Review
. 2021 Apr 9:76:e2342.
doi: 10.6061/clinics/2021/e2342. eCollection 2021.

Renin-Angiotensin-Aldosterone System Inhibitors in COVID-19: A Review

Filipe Ferrari  1 , Vítor Magnus Martins  2 , Flávio Danni Fuchs  1   3 , Ricardo Stein  1   4
Affiliations
Review

Renin-Angiotensin-Aldosterone System Inhibitors in COVID-19: A Review

Filipe Ferrari et al. Clinics (Sao Paulo). .

Abstract

Among the multiple uncertainties surrounding the novel coronavirus disease (COVID-19) pandemic, a research letter published in The Lancet implicated drugs that antagonize the renin-angiotensin-aldosterone system (RAAS) in an unfavorable prognosis of COVID-19. This report prompted investigations to identify mechanisms by which blocking angiotensin-converting enzyme 2 (ACE2) could lead to serious consequences in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The possible association between RAAS inhibitors use and unfavorable prognosis in this disease may have been biased by the presence of underlying cardiovascular diseases. As the number of COVID-19 cases has increased worldwide, it has now become possible to investigate the association between RAAS inhibitors and unfavorable prognosis in larger cohorts. Observational studies and one randomized clinical trial failed to identify any consistent association between the use of these drugs and unfavorable prognosis in COVID-19. In view of the accumulated clinical evidence, several scientific societies recommend that treatment with RAAS inhibitors should not be discontinued in patients diagnosed with COVID-19 (unless contraindicated). This recommendation should be followed by clinicians and patients.

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Conflict of interest statement

No potential conflict of interest was reported.

Figures

Figure 1
Figure 1. Renin-angiotensin-aldosterone system and drugs that act on this system. MasR: Mas receptor; ACE1: ACE2: Angiotensin-converting enzyme 2.
See this image and copyright information in PMC

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