Quality of evidence: D
SARS-CoV2: should inhibitors of the renin-angiotensin system be withdrawn in patients with COVID-19?
Authors: Kuster GM et al
Journal: European Heart Journal
Objectives: Assess the impact of renin-angiotensin inhibitors on infection and mortality
Strength of evidence: Low (methods lacking, in vitro data, numerous conflict of interests from pharmaceutical companies)
Methods/publication type: Review of the literature
Highlights :
ACE2 receptors used by SARS-CoV to enter cells
Inhibitor of the renin-angiotensin system linked to an increase in ACE2 expression
The link between increased expression of ACE2 and mortality from SARS-CoV-2 is not known
Presence of SARS-CoV in cells lacking an ACE2 receptor = other cofactors needed
In mice, lung damage is reduced by the administration of inhibitors
Confounding factor: cardiovascular comorbidities and older age associated with intake of inhibitors
Certain studies suggest a deleterious effect of the renin-angiotensin system
Recommendation: don't change the current status. ACE-I and ARB therapy should be maintained or initiated in patients with heart failure, hypertension, or myocardial infarction
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