Angiotensin-Converting Enzyme Inhibitor / Angiotensin II Receptor Blocker in COVID-19: a Double-edged Sword or a Myth

Keywords: Acute respiratory syndrome, Angiotensin-converting enzyme, Angiotensin II receptor, Blocker, Coronavirus, COVID-19, Inhibitor

Abstract

Angiotensin-converting enzyme-2 receptor has been unearthed as a prime site of entry of Severe Acute Respiratory Syndrome Coronavirus 2 owing to its strong affinity towards spike protein of Severe Acute Respiratory Syndrome Coronavirus 2, resulting in down-regulation of Angiotensin-converting enzyme -2 receptors and hyperstimulation of Angiotensin-converting enzyme-1 pathway. This proposed theory has led to the birth of a new controversy regarding the use of Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers in Coronavirus disease 2019 patients. A theory is against the use of Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, as it enhances the effect of Angiotensin-converting enzyme -2 pathway and upregulation of Angiotensin-converting enzyme -2 receptors resulting in a large number of internalizations of Severe Acute Respiratory Syndrome Coronavirus -2 into cells culminating into a high load of viremia with overwhelming infection and severity. The other theory considers Angiotensin-converting enzyme inhibitors / Angiotensin receptor blockers useful as it blocks deleterious Angiotensin-converting enzyme -1 pathway triggered by Severe Acute Respiratory Syndrome Coronavirus 2 and enhances Angiotensin-converting enzyme -2 receptor upregulation and activation of angiotensin-(1-7) leading to beneficial effects, i.e vasodilation, anti-apoptosis, anti-proliferative, & antifibrosis. Hence, Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers may prove beneficial in countering the Angiotensin-converting enzyme -1 mediated damage by Severe Acute Respiratory Syndrome Coronavirus 2. The recommendations by (European & American) societal guidelines still hold good of not discontinuing Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers in COVID-19 patients as it is further supported by current evidence of large observational studies.  

Downloads

Download data is not yet available.
Abstract
422
PDF
93

Author Biographies

Kunal Bikram Shaha, Patan Academy of Health Sciences,PAHS,patan

Assistant Professor, Department of Internal medicine, Cardiology, Patan Academy of Health Sciences, Lalitpur, Nepal

Ashok Adhikari, Patan Academy of Health Sciences,PAHS,patan

Lecturer, Department of Internal Medicine,Division cardiology

Jung Rae Cho, Kangnam Sacred Heart Hospital,HUMC,Korea

Professor, Interventional Cardiologist and cath-Lab Director

Department of Internal Medicine,Division cardiology

Bimal Pandey, Patan Academy of Health Sciences,PAHS,patan

Assistant Professor

Department of Internal Medicine,Division Nephrology

Yubaraj Sharma, Patan Academy of Health Sciences,PAHS,patan

Professor

HOD,departemnt of Internal Medicine and Gastroenterolgy Division

Sajjad Safi, Patan Academy of Health Sciences,PAHS,patan

Lecturer

Department of Internal Medicine,Cardiology Division

 

Published
2020-05-27
How to Cite
Shaha, K., Adhikari, A., Cho, J., Pandey, B., Sharma, Y., & Safi, S. (2020). Angiotensin-Converting Enzyme Inhibitor / Angiotensin II Receptor Blocker in COVID-19: a Double-edged Sword or a Myth. Nepalese Medical Journal, 3(1), 309-312. https://doi.org/10.3126/nmj.v3i1.28726
Section
Review Articles