Sunday, March 29, 2020

COVID-19: ACE-inhibitors and SARS-Co-V2

Nowadays, many are aware of the pandemic spreading all around the world and causing victims on a daily basis. This infection which appears for the first time at Wuhan in China represents a great concern. Today, let us explore some questions relating to the disease.

1) ACE-inhibitors and SARS-Co-V2, what is the link existing between them?
The angiotensin-converting-enzyme is secreted by pneumocytes 2 of the lungs and allows the conversion of angiotensin 1 to angiotensin 2, a powerful vasoconstrictor. The receptors for this enzyme are found in various places, including the heart and lungs. Normally, the inhibitor of this enzyme is used in case of high blood pressure, coronary heart disease and also diabetes thanks to its protective effect for the kidneys. However, in the context of COVID19 infection, the virus (SARS-Cov2) uses the converting enzyme receptors to enter the lungs. Given the increase in the number of these receptors in the event of therapy based on ACE inhibitors, the maintenance of this drug in patients infected with SARS-Cov2 is controversial.
2) Are patients with hypertension and diabetes at increased risk for COVID-19 infection?
About the comorbidities, it is seen that during the first analyses of patient's characteristics from China diabetes, hypertension and cardiovascular diseases are highly prevalent among SARS-Cov2 infected patients. It may be associated with poor outcomes according to a study published in the New England Journal of medicine 2020: “Clinical characteristics of coronavirus disease 2019 in China" by Guan WJ and al. Dr. Zunyou Whu (epidemiologist, Chinese center of disease control and prevention) mentioned that 40% of the infected patients are hypertensives and 20% are diabetics.

3) Should inhibitors of the renin-angiotensin system be withdrawn in patients with COVID-19?
Basing on the available data, withdrawal of RAAS inhibition or preemptive switch to alternate drugs is not advised. ACE-inhibitor therapy should be maintained or initiated in patients with heart failure, hypertension or myocardial infarction according to current guidelines as tolerated, irrespective of SARS-Cov2. Instead of improving, the withdraw of RAAS inhibition might even increase cardiovascular mortality in critically ill COVID-19 patients. Pflugfelder and al: "Clinical consequences of angiotensin-converting enzyme inhibitor withdrawal in chronic heart failure: a double-blind placebo-controlled study of quinapril". The quinapril heart failure trial investigators. J Am Coll Cardiol.

Written by Rebecca ST LOUIS
6th grade at the State University of Haiti's Hospital.

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