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COVID-19 and Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor BlockersWhat Is the Evidence?

Educational Objective
Review if there is a link between COVID-19 and Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers
1 Credit CME

Coronavirus disease 2019 (COVID-19) is a current pandemic infection caused by a positive-sense RNA virus named the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The particularly infectious capacity of the virus, along with mortality rates ranging from 1% to above 5%, has raised concerns across the globe.1 Older patients with comorbid conditions including pulmonary disease, cardiac disease, kidney disease, diabetes, and hypertension have been associated with even higher mortality rates, suggesting particularly susceptible populations.

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Article Information

Corresponding Author: Ankit B. Patel, MD, PhD, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115 (apatel38@bwh.harvard.edu).

Published Online: March 24, 2020. doi:10.1001/jama.2020.4812

Conflict of Interest Disclosures: None reported.

References
1.
Wu  Z , McGoogan  JM .  Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention.   JAMA. Published online February 24, 2020. doi:10.1001/jama.2020.2648 PubMedGoogle Scholar
2.
Wu  C , Chen  X , Cai  Y ,  et al.  Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China.   JAMA Intern Med. Published online March 13, 2020. doi:10.1001/jamainternmed.2020.0994PubMedGoogle Scholar
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Zhou  F , Yu  T , Du  R ,  et al.  Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.   Lancet. 2020;S0140-6736(20)30566-3. doi:10.1016/S0140-6736(20)30566-3PubMedGoogle Scholar
4.
Zhou  P , Yang  X-L , Wang  X-G ,  et al.  A pneumonia outbreak associated with a new coronavirus of probable bat origin.   Nature. 2020;579(7798):270-273. doi:10.1038/s41586-020-2012-7PubMedGoogle ScholarCrossref
5.
Rice  GI , Thomas  DA , Grant  PJ , Turner  AJ , Hooper  NM .  Evaluation of angiotensin-converting enzyme (ACE), its homologue ACE2 and neprilysin in angiotensin peptide metabolism.   Biochem J. 2004;383(pt 1):45-51. doi:10.1042/BJ20040634PubMedGoogle ScholarCrossref
6.
Kuba  K , Imai  Y , Rao  S ,  et al.  A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus-induced lung injury.   Nat Med. 2005;11(8):875-879. doi:10.1038/nm1267PubMedGoogle ScholarCrossref
7.
Khan  A , Benthin  C , Zeno  B ,  et al.  A pilot clinical trial of recombinant human angiotensin-converting enzyme 2 in acute respiratory distress syndrome.   Crit Care. 2017;21(1):234.PubMedGoogle ScholarCrossref
8.
European Society of Cardiology. Position statement of the ESC Council on Hypertension on ACE-inhibitors and angiotensin receptor blockers. Published March 13, 2020. Accessed March 20, 2020. https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang
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American Heart Association. HFSA/ACC/AHA statement addresses concerns re: using RAAS antagonists in COVID-19. Accessed March 20, 2020. https://professional.heart.org/professional/ScienceNews/UCM_505836_HFSAACCAHA-statement-addresses-concerns-re-using-RAAS-antagonists-in-COVID-19.jsp
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