Division of Cardiology, Department of Internal Medicine and Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC 27709, USA.
Pharmacol Ther. 2020 Nov;215:107628. doi: 10.1016/j.pharmthera.2020.107628. Epub 2020 Jul 9.
The coronavirus disease 2019 (COVID-19) pandemic is caused by a newly emerged coronavirus (CoV) called Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2). COVID-19 patients with cardiovascular disease (CVD) comorbidities have significantly increased morbidity and mortality. The use of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor type 1 blockers (ARBs) improve CVD outcomes; however, there is concern that they may worsen the prognosis of CVD patients that become infected with SARS-CoV-2 because the virus uses the ACE2 receptor to bind to and subsequently infect host cells. Thus, some health care providers and media sources have questioned the continued use of ACE inhibitors and ARBs. In this brief review, we discuss the effect of ACE inhibitor-induced bradykinin on the cardiovascular system, on the renin-angiotensin-aldosterone system (RAAS) regulation in COVID-19 patients, and analyze recent clinical studies regarding patients treated with RAAS inhibitors. We propose that the application of RAAS inhibitors for COVID-19 patients with CVDs may be beneficial rather than harmful.
新型冠状病毒（SARS-CoV-2）引发的 2019 年冠状病毒病（COVID-19）大流行。患有心血管疾病（CVD）合并症的 COVID-19 患者发病率和死亡率显著增加。血管紧张素转换酶（ACE）抑制剂和血管紧张素 II 受体 1 型阻滞剂（ARBs）改善 CVD 结局；然而，人们担心它们可能会使感染 SARS-CoV-2 的 CVD 患者的预后恶化，因为该病毒使用 ACE2 受体与宿主细胞结合并随后感染宿主细胞。因此，一些医疗保健提供者和媒体资源质疑继续使用 ACE 抑制剂和 ARBs。在这篇简短的综述中，我们讨论了 ACE 抑制剂诱导的缓激肽对心血管系统的影响，以及在 COVID-19 患者中对肾素-血管紧张素-醛固酮系统（RAAS）的调节，并分析了最近关于接受 RAAS 抑制剂治疗的患者的临床研究。我们提出，RAAS 抑制剂在 CVD 合并 COVID-19 的患者中的应用可能是有益的而不是有害的。
