march 2020 • European Heart Journal

SARS-CoV2: should inhibitors of the renin–angiotensin system be withdrawn in patients with COVID-19?

Gabriela M Kuster, Otmar Pfister, Thilo Burkard, Qian Shou, et al.

DOI: 10.1093/eurheartj/ehaa235

Key message

Com base na evidência atualmente disponível e tendo em conta o comprovado benefício de redução da mortalidade em doenças cardiovasculares, a terapêutica com iECAs e ARAs deve ser mantida, ou até iniciada em doentes com insuficiência cardíaca, hipertensão arterial ou enfarte agudo do miocárdio, independentemente de infeção por SARS-CoV-2. A suspensão destes fármacos ou a sua substituição não é aconselhada uma vez que poderá levar a um aumento da mortalidade cardiovascular em doentes em estado crítico por COVID-19.

Abstract

In a rapid response published online by the British Medical Journal, Sommerstein and Gräni1 pushed forward the hypothesis that angiotensin-converting enzyme (ACE) inhibitors (ACE-Is) could act as a potential risk factor for fatal Corona virus disease 2019 (COVID-19) by up-regulating ACE2. This notion was quickly picked up by the lay press and sparked concerns among physicians and patients regarding the intake of inhibitors of the renin–angiotensin–aldosterone system (RAAS) by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infected individuals.In this article, we try to shed light on what is known and unknown regarding the RAAS and SARS-CoV2 interaction. We find translational evidence for diverse roles of the RAAS, which allows to formulate also the opposite hypothesis, i.e. that inhibition of the RAAS might be protective in COVID-19.