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Renin-angiotensin system blockade in the COVID-19 pandemic.

Publication ,  Journal Article
Cohen, JB; South, AM; Shaltout, HA; Sinclair, MR; Sparks, MA
Published in: Clin Kidney J
March 2021

In the early months of the coronavirus disease 2019 (COVID-19) pandemic, a hypothesis emerged suggesting that pharmacologic inhibitors of the renin-angiotensin system (RAS) may increase COVID-19 severity. This hypothesis was based on the role of angiotensin-converting enzyme 2 (ACE2), a counterregulatory component of the RAS, as the binding site for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), allowing viral entry into host cells. Extrapolations from prior evidence led to speculation that upregulation of ACE2 by RAS blockade may increase the risk of adverse outcomes from COVID-19. However, counterarguments pointed to evidence of potential protective effects of ACE2 and RAS blockade with regard to acute lung injury, as well as substantial risks from discontinuing these commonly used and important medications. Here we provide an overview of classic RAS physiology and the crucial role of ACE2 in systemic pathways affected by COVID-19. Additionally, we critically review the physiologic and epidemiologic evidence surrounding the interactions between RAS blockade and COVID-19. We review recently published trial evidence and propose important future directions to improve upon our understanding of these relationships.

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Published In

Clin Kidney J

DOI

ISSN

2048-8505

Publication Date

March 2021

Volume

14

Issue

Suppl 1

Start / End Page

i48 / i59

Location

England

Related Subject Headings

  • 3202 Clinical sciences
 

Citation

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Cohen, J. B., South, A. M., Shaltout, H. A., Sinclair, M. R., & Sparks, M. A. (2021). Renin-angiotensin system blockade in the COVID-19 pandemic. Clin Kidney J, 14(Suppl 1), i48–i59. https://doi.org/10.1093/ckj/sfab026
Cohen, Jordana B., Andrew M. South, Hossam A. Shaltout, Matthew R. Sinclair, and Matthew A. Sparks. “Renin-angiotensin system blockade in the COVID-19 pandemic.Clin Kidney J 14, no. Suppl 1 (March 2021): i48–59. https://doi.org/10.1093/ckj/sfab026.
Cohen JB, South AM, Shaltout HA, Sinclair MR, Sparks MA. Renin-angiotensin system blockade in the COVID-19 pandemic. Clin Kidney J. 2021 Mar;14(Suppl 1):i48–59.
Cohen, Jordana B., et al. “Renin-angiotensin system blockade in the COVID-19 pandemic.Clin Kidney J, vol. 14, no. Suppl 1, Mar. 2021, pp. i48–59. Pubmed, doi:10.1093/ckj/sfab026.
Cohen JB, South AM, Shaltout HA, Sinclair MR, Sparks MA. Renin-angiotensin system blockade in the COVID-19 pandemic. Clin Kidney J. 2021 Mar;14(Suppl 1):i48–i59.

Published In

Clin Kidney J

DOI

ISSN

2048-8505

Publication Date

March 2021

Volume

14

Issue

Suppl 1

Start / End Page

i48 / i59

Location

England

Related Subject Headings

  • 3202 Clinical sciences