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Fundam Clin Pharmacol
. 2020 Dec 8.
doi: 10.1111/fcp.12637. Online ahead of print.
Outcome of patients hospitalized for Covid-19 and exposure to angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers in France: Results of the ACECoV study
Joachim Alexandre 1 , Jean-Luc Cracowski 2
Affiliations
- PMID: 33290594
- DOI: 10.1111/fcp.12637
Abstract
During the spread of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), early reports indicated that certain groups of patients were at risk of developing severe COVID-19 infections. This included patients with arterial hypertension and cardiovascular diseases [1]. Many of those patients were treated with angiotensin converting enzyme 1 inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs). SARS-CoV2- utilizes angiotensin-converting enzyme 2 (ACE2) as a membrane receptor to enter target cells [2]. Due to different chemical structures with ACE1, ACE2 is insensitive to ACEIs. ACEIs and ARBs may increase the amount of ACE-2 formation and, theoretically, increase the risk of SARS-CoV-2 entry into cells, thus inducing inflammation [2]. The fear that ACEI or ARB might facilitate COVID-19 infections and increase the risk of developing severe or fatal severe acute respiratory syndrome in case of COVID-19 infection emerged [3]. The question is all the more delicate as arterial hypertension and cardiovascular diseases are very common in the general population, especially in the elderly, for which ACEIs/ARBs are prescribed in 25-30% of cases [4]. In response, many scientific organizations and journals issued statements cautioning against discontinuation of these agents due to the lack of evidence of harm, and because discontinuation would predictably lead to uncontrolled blood pressure with its own cardiovascular disease risks. Moreover, direct evidence from COVID-19-infected patients, taking or not taking these agents, and on which reliable recommendations could be based, was not yet available.