Coronavirus Disease 2019 and Hypertension: The Role of Angiotensin-Converting Enzyme 2 and the Renin-Angiotensin System.

Journal Article (Journal Article;Review)

Hypertension emerged from early reports as a potential risk factor for worse outcomes for persons with coronavirus disease 2019 (COVID-19). Among the putative links between hypertension and COVID-19 is a key counter-regulatory component of the renin-angiotensin system (RAS): angiotensin-converting enzyme 2 (ACE2). ACE2 facilitates entry of severe acute respiratory syndrome coronavirus 2, the virus responsible for COVID-19, into host cells. Because RAS inhibitors have been suggested to increase ACE2 expression, health-care providers and patients have grappled with the decision of whether to discontinue these medications during the COVID-19 pandemic. However, experimental models of analogous viral pneumonias suggest RAS inhibitors may exert protective effects against acute lung injury. We review how RAS and ACE2 biology may affect outcomes in COVID-19 through pulmonary and other systemic effects. In addition, we briefly detail the data for and against continuation of RAS inhibitors in persons with COVID-19 and summarize the current consensus recommendations from select specialty organizations.

Full Text

Duke Authors

Cited Authors

  • Edmonston, DL; South, AM; Sparks, MA; Cohen, JB

Published Date

  • September 2020

Published In

Volume / Issue

  • 27 / 5

Start / End Page

  • 404 - 411

PubMed ID

  • 33308506

Pubmed Central ID

  • PMC7334971

Electronic International Standard Serial Number (EISSN)

  • 1548-5609

Digital Object Identifier (DOI)

  • 10.1053/j.ackd.2020.07.002


  • eng

Conference Location

  • United States