Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in the time of COVID-19: what the evidence suggests

Abstract

Coronavirus disease 2019 (COVID-19) remains of global concern due to its devastating impact on human health. Several comorbidities have already been established as risk factors for poor outcome, with cardiovascular disorders among them. Given the mechanistic attributes of several drug classes, much contention has been raised about the benefit and/or risk of using some while COVID-19-positive. The antihypertensive angiotensin converting enzyme inhibitor (ACE-I) and angiotensin II receptor blocker (ARB) drug classes are among these that have received attention due to their overlapping biological properties with the angiotensin-converting enzyme-2 metallopeptidase; this enzyme facilitates viral entry of the severe acute respiratory syndrome coronavirus-2. Although there are theoretical risks, to date, no studies have shown an increased risk of using these drug classes during COVID-19, with some suggesting potential benefit of use. Given the evidence available, and without robust enough trials available to show otherwise, current recommendations are that starting or discontinuing ACE-I or ARB treatment during COVID-19 should only be guided by hypertension clinical practice guidelines and not the COVID-19 status of the patient.