Is the use of RAS inhibitors safe in the current era of COVID-19 pandemic?
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Antihypertensive drugs are one of the most widely used pharmacologic agent in the world and it is predominantly used in the elderly subjects. Pneumonia is the most common cause of death in the extremely old subject. During infection and its complication such as sepsis, hypotension could be exacerbated by antihypertensive drugs because homeostasis mechanisms such as sodium balance, renin angiotensin aldosterone system and/or sympathetic nervous system can be mitigated by antihypertensive drug therapy. Severe Acute Respiratory Syndrome-Coronavirus-1 and 2 viral surface protein is known to attach angiotensin converting enzyme 2 (ACE2) on the cell membrane to facilitate viral entry into the cytoplasm. Despite the theoretical concerns of increased ACE2 expression by Renin-AngiotensinAldosterone system (RAS) blockade, there is no evidence that RAS inhibitors are harmful during COVID-19 infection and have in fact been shown to be beneficial in animal studies. Therefore, it is recommended to maintain RAS blockade during the current corona virus pandemic.
Abstract
Antihypertensive drugs are one of the most widely used pharmacologic agent in the world and it is predominantly used in the elderly subjects. Pneumonia is the most common cause of death in the extremely old subject. During infection and its complication such as sepsis, hypotension could be exacerbated by antihypertensive drugs because homeostasis mechanisms such as sodium balance, renin angiotensin aldosterone system and/or sympathetic nervous system can be mitigated by antihypertensive drug therapy. Severe Acute Respiratory Syndrome-Coronavirus-1 and 2 viral surface protein is known to attach angiotensin converting enzyme 2 (ACE2) on the cell membrane to facilitate viral entry into the cytoplasm. Despite the theoretical concerns of increased ACE2 expression by Renin-AngiotensinAldosterone system (RAS) blockade, there is no evidence that RAS inhibitors are harmful during COVID-19 infection and have in fact been shown to be beneficial in animal studies. Therefore, it is recommended to maintain RAS blockade during the current corona virus pandemic.
참고문헌 (20)
- Hsu WT, "Effect of reninangiotensin-aldosterone system inhibitors on short-term mortality after Sepsis : a population-based cohort study", Hypertension, 75, pp.483~491 (2020)
- Hsu CT, "Depressed sympathovagal modulation indicates sepsis in patients with suspected infection", Medicine(Baltimore), 99, pp.e18961~ (2020)
- Gilstrap LG, "Initiation, continuation, or withdrawal of angiotensin-converting enzyme inhibitors", angiotensin receptor blockers and outcomes in patients hospitalized with heart failure with reduced ejection fraction, 2017, pp.6, ~
- Prins KW, "Effects of Beta-blocker withdrawal in acute decompensated heart failure : a systematic review and meta-analysis", JACC Heart Fail, 3, pp.647~653 (2015)
- Ohkubo T, "Effects of an angiotensin-converting enzyme inhibitor-based regimen on pneumonia risk", Am J Respir Crit Care Med, 169, pp.1041~1045 (2004)
- 이주희, "KSHF Guidelines for the Management of Acute Heart Failure; Part II: Treatment of Acute Heart Failure", Korean Circulation Journal, 49(1), pp.22~45 (2019), 대한심장학회[DOI]
- British Infection S, "Pandemic flu:clinical management of patients with an influenza-like illness during an influenza pandemic. Provisional guidelines from the British Infection Society, British Thoracic Society, and Health Protection Agency in collaboration with the Department of Health", Thorax, 62(Suppl 1), pp.1~46 (2007)
- Arendse LB, "Novel therapeutic approaches targeting the reninangiotensin system and associated peptides in hypertension and heart failure", Pharmacol Rev, 71, pp.539~570 (2019)
- Tipnis SR, "A human homolog of angiotensin-converting enzyme. Cloning and functional expression as a captopril-insensitive carboxypeptidase", J Biol Chem, 275, pp.33238~33243 (2000)
- Zhou F, "Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study", Lancet (2020)
- Guan WJ, "Clinical characteristics of coronavirus disease 2019 in China", N Engl J Med (2019)
- Hamming I, "Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis", J Pathol, 203, pp.631~637 (2004)
- Kuba K, "A crucial role of angiotensin converting enzyme 2(ACE2)in SARS coronavirus-induced lung injury", Nat Med, 11, pp.875~879 (2005)
- Wrapp D, "Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation", Science, 367, pp.1260~1263 (2020)
- Zambelli V, "Angiotensin-(1-7)improves oxygenation, while reducing cellular infiltrate and fibrosis in experimental acute respiratory distress syndrome", Intensive Care Med Exp, 3, pp.44~ (2015)
- Burrell LM, "Myocardial infarction increases ACE2 expression in rat and humans", Eur Heart J, 26, pp.369~375 (2005)
- Walters TE, "Angiotensin converting enzyme 2 activity and human atrial fibrillation : increased plasma angiotensin converting enzyme 2 activity is associated with atrial fibrillation and more advanced left atrial structural remodelling", Europace, 19, pp.1280~1287 (2017)
- Deshotels MR, "Angiotensin II mediates angiotensin converting enzyme type 2 internalization and degradation through an angiotensin II type I receptor-dependent mechanism", Hypertension, 64, pp.1368~1375 (2014)
- Heurich A, "TMPRSS2 and ADAM17 cleave ACE2 differentially and only proteolysis by TMPRSS2 augments entry driven by the severe acute respiratory syndrome coronavirus spike protein", J Virol, 88, pp.1293~1307 (2014)
- Imai Y, "Angiotensin-converting enzyme 2 protects from severe acute lung failure", Nature, 436, pp.112~116 (2005)
