Professor of Pharmacology Retired, MOSC Medical College, Kolenchery, Kerala, India, Corresponding Author.
J Assoc Physicians India. 2023 Nov;71(11):71-75. doi: 10.59556/japi.71.0393.
Overactivity of the renin-angiotensin-aldosterone system (RAAS) is a consistent feature of COVID-19 as indicated by high concentrations of angiotensin II (Ang II) in lungs and other tissues. Virus-induced downregulation of angiotensin-converting enzyme-2 (ACE2) explains the raised Ang II levels. Available evidence points to the crucial role of Ang II in the pathogenesis of coronavirus disease. The proinflammatory, immune stimulant, and procoagulant effects exhibited by the peptide at high tissue levels explain lung injury, a characteristic feature of severe COVID-19. Angiotensin II (Ang II) inhibitors [both the angiotensin-converting enzyme inhibitors (ACEIs) and the angiotensin receptor blockers (ARBs)] constitute the logical therapy for established COVID-19 infection. While ACEIs help to lower Ang II levels in the tissues, ARBs antagonize the effects of the peptide on the target tissues. Of the two, ARBs offer a better choice because of the minimal adverse effects of dry cough and angioedema. The effectiveness of Ang II inhibitors in COVID-19 is well supported by their protective effect against lung injury in animals induced by the virus spike protein as well as the clinical improvement of shortened hospital stay and reduced mortality in observational studies in humans. A unique feature of these agents is that mutations of the coronavirus 2 (CoV-2) would have little impact on their effectiveness since they do not interfere with the host cell entry of the virus or its replication. Expectedly, the agents might retain their usefulness against variant strains, including "ο" and its subvariants. The overall safety of Ang II inhibitors has been well established beyond doubt since they have been in use for years in the management of cardiovascular (CV) diseases, diabetes mellitus, and chronic kidney disease (CKD). Regular use of ARBs in all patients who are COVID-19 positive and symptomatic (mild, moderate, or severe) offers a good option worth serious consideration. : S HT. COVID-19 Therapeutics Why Not Angiotensin Receptor Blockers (ARBs)? J Assoc Physicians India 2023;71(11):71-75.
血管紧张素转换酶-2（ACE2）的病毒诱导下调解释了升高的 Ang II 水平。现有证据表明 Ang II 在冠状病毒疾病的发病机制中起关键作用。该肽在高组织水平上表现出的促炎、免疫刺激和促凝作用解释了肺损伤，这是严重 COVID-19 的一个特征。血管紧张素 II（Ang II）抑制剂[包括血管紧张素转换酶抑制剂（ACEIs）和血管紧张素受体阻滞剂（ARBs）]是治疗已确诊 COVID-19 感染的合理选择。虽然 ACEIs 有助于降低组织中的 Ang II 水平，但 ARBs 拮抗肽对靶组织的作用。在这两种药物中，ARBs 是更好的选择，因为它们引起干咳和血管性水肿的不良反应最小。Ang II 抑制剂在 COVID-19 中的有效性得到了很好的支持，因为它们对病毒刺突蛋白诱导的动物肺损伤具有保护作用，以及在人类观察性研究中缩短住院时间和降低死亡率的临床改善。这些药物的一个独特特征是，冠状病毒 2（CoV-2）的突变对其有效性影响不大，因为它们不干扰病毒进入宿主细胞或其复制。可以预期，这些药物可能对包括“ο”及其亚变种在内的变异株仍然有用。Ang II 抑制剂的总体安全性毋庸置疑，因为它们在心血管（CV）疾病、糖尿病和慢性肾脏病（CKD）的治疗中已经使用了多年。在所有 COVID-19 阳性和有症状（轻度、中度或重度）的患者中常规使用 ARBs 是一个值得认真考虑的不错选择。
