Use of RAS inhibitors in patients with COVID-19

Some concerns about the prescription of drugs acting on the renin-angiotensin system (RAS) have emerged due to SARS COV2 and COVID-19 pandemic and the revelation of the fundamental role of ACE2 (angiotensin-converting enzyme 2) in COVID-19 infection. Indeed, SARS COV2 utilizes ACE2 as a membrane receptor to enter target cells. Consequently, the question arises whether RAS modulating drugs impact the risk of developing severe or fatal severe acute respiratory syndrome in case of COVID-19 infection.  Here we discuss the evidence avilable on the impact of angiotensin-converting enzyme 1 inhibitors (ACEi) versus angiotensin II type 1 receptor blockers (ARB). Based on the currently available evidences, and as recommended by several medical societies, ACEi or ARB should not be systematically discontinued because to date no safety signal was raised with the use of these drugs.

Alexandre J, Cracowski JL, Richard V, Bouhanick B; French Society of Pharmacology and Therapeutics (SFPT). Drugs acting on renin angiotensin system and use in ill patients with COVID-19. Therapie. 2020;75(4):319-325.

doi: 10.1016/j.therap.2020.05.009.. PMID: 32553503