McLachlan Craig Steven
Torrens University Australia, Health Vertical, 5/235 Pyrmont St, Pyrmont, NSW 2009 Australia.
Clin Hypertens. 2020 Jul 15;26:14. doi: 10.1186/s40885-020-00147-x. eCollection 2020.
There is current debate concerning the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II type 1 receptor blockers (ARBs), for hypertension management, during COVID-19 infection. Specifically, the suggestion has been made that ACE inhibitors or ARBs could theoretically contribute to infection via increasing ACE2 receptor expression and hence increase viral load. The ACE2 receptor is responsible for binding the SAR-CoV2 viral spike and causing COVID-19 infection. What makes the argument somewhat obtuse for ACE inhibitors or ARBs is that ACE2 receptor expression can be increased by compounds that activate or increase the expression of SIRT1. Henceforth common dietary interventions, vitamins and nutrients may directly or indirectly influence the cellular expression of the ACE2 receptor. There are many common compounds that can increase the expression of the ACE2 receptor including Vitamin C, Metformin, Resveratrol, Vitamin B3 and Vitamin D. It is important to acknowledge that down-regulation or blocking the cellular ACE2 receptor will likely be pro-inflammatory and may contribute to end organ pathology and mortality in COVID-19. In conclusion from the perspective of the ACE2 receptor, COVID-19 prevention and treatment are distinctly different. This letter reflects on this current debate and suggests angiotensin-converting enzyme inhibitors and ARBs are likely beneficial during COVID-19 infection for hypertensive and normotensive patients.
目前关于在2019冠状病毒病（COVID-19）感染期间使用血管紧张素转换酶（ACE）抑制剂或血管紧张素II 1型受体阻滞剂（ARB）进行高血压管理存在争议。具体而言，有人提出，ACE抑制剂或ARB理论上可能通过增加ACE2受体表达从而增加病毒载量，进而导致感染。ACE2受体负责结合严重急性呼吸综合征冠状病毒2（SARS-CoV2）病毒刺突并引发COVID-19感染。而对于ACE抑制剂或ARB来说，情况有些复杂的是，激活或增加沉默信息调节因子1（SIRT1）表达的化合物也能增加ACE2受体表达。因此，常见的饮食干预、维生素和营养物质可能直接或间接影响ACE2受体的细胞表达。有许多常见化合物可增加ACE2受体表达，包括维生素C、二甲双胍、白藜芦醇、维生素B3和维生素D。必须认识到，下调或阻断细胞ACE2受体会可能具有促炎作用，并可能导致COVID-19患者出现终末器官病变和死亡。总之，从ACE2受体的角度来看，COVID-19的预防和治疗截然不同。这封信对当前的这场争论进行了反思，并指出血管紧张素转换酶抑制剂和ARB对COVID-19感染期间的高血压和血压正常患者可能有益。
