More About Effects of Renin–Angiotensin System Inhibitors in Patients with COVID-19

Angiotensin-converting enzyme 2 (ACE2) is a receptor for SARS-CoV-2 and facilitates viral entry into host cells. Some clinicians and researchers have been concerned that angiotensin-converting–enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) might increase ACE2 expression and perhaps promote SARS-CoV-2 infection or increase COVID-19 severity.

In two trials, one comprising 150 adults in seven countries hospitalized with COVID-19 and another comprising 650 adults hospitalized in Brazil with mild-to-moderate COVID-19, researchers randomly assigned patients to continue or discontinue their previously prescribed ACE inhibitors or ARBs. The international trial showed that continuation did not significantly affect time to all-cause death, length of hospitalization or intensive care unit stay, duration of mechanical ventilation, time on renal replacement or vasopressor therapy, or multiorgan dysfunction. The Brazilian trial showed no significant difference in all-cause death, number of days alive and out of the hospital, cardiovascular-related death, or COVID-19 progression at 30 days.