Programa de Pos-Graduacao em Cardiologia e Ciencias Cardiovasculares, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR.
Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, BR.
Clinics (Sao Paulo). 2021 Apr 9;76:e2342. doi: 10.6061/clinics/2021/e2342. eCollection 2021.
Among the multiple uncertainties surrounding the novel coronavirus disease (COVID-19) pandemic, a research letter published in The Lancet implicated drugs that antagonize the renin-angiotensin-aldosterone system (RAAS) in an unfavorable prognosis of COVID-19. This report prompted investigations to identify mechanisms by which blocking angiotensin-converting enzyme 2 (ACE2) could lead to serious consequences in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The possible association between RAAS inhibitors use and unfavorable prognosis in this disease may have been biased by the presence of underlying cardiovascular diseases. As the number of COVID-19 cases has increased worldwide, it has now become possible to investigate the association between RAAS inhibitors and unfavorable prognosis in larger cohorts. Observational studies and one randomized clinical trial failed to identify any consistent association between the use of these drugs and unfavorable prognosis in COVID-19. In view of the accumulated clinical evidence, several scientific societies recommend that treatment with RAAS inhibitors should not be discontinued in patients diagnosed with COVID-19 (unless contraindicated). This recommendation should be followed by clinicians and patients.
在围绕新型冠状病毒病 (COVID-19) 大流行的诸多不确定因素中，柳叶刀杂志上发表的一篇研究通讯暗示，肾素-血管紧张素-醛固酮系统 (RAAS) 的拮抗剂药物与 COVID-19 的不良预后有关。这一报道促使人们开展研究，以确定阻断血管紧张素转换酶 2 (ACE2) 如何导致严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 的严重后果。RAAS 抑制剂的使用与该疾病不良预后之间的可能关联可能受到潜在心血管疾病的影响。随着 COVID-19 病例在全球范围内的增加，现在有可能在更大的队列中研究 RAAS 抑制剂与不良预后之间的关系。观察性研究和一项随机临床试验均未能确定这些药物的使用与 COVID-19 的不良预后之间存在任何一致的关联。鉴于临床证据的积累，一些科学协会建议，在 COVID-19 诊断患者中不应停止使用 RAAS 抑制剂（除非禁忌）。临床医生和患者都应遵循这一建议。
