Antihypertensive medication uses and serum ACE2 levels: ACEIs/ARBs treatment does not raise serum levels of ACE2

Emilsson, Valur; Gudmundsson, Elias F.; Aspelund, Thor; Jonsson, Brynjolfur G.; Gudjonsson, Alexander; Launer, Lenore J.; Jennings, Lori L.; Gudmundsdottir, Valborg; Gudnason, Vilmundur

IMPORTANCE: Recent reports have shown that hypertension is the most common comorbidity associated with mortality in the current coronavirus disease 2019 (COVID-19). This has been related to the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) as animal studies indicate that these medications increase levels of ACE2, the cellular entry point for the coronavirus SARS-CoV-2. This has prompted clinicians to recommend discontinuing ACEIs and ARBs. OBJECTIVE: To examine the effect of ACEIs or ARBs treatment on serum levels of ACE2 and other key enzymes in the renin-angiotensin system (RAS). DESIGN, SETTING, AND PARTICIPANTS: A single center population-based study of 5457 Icelanders from the Age, Gene/Environment Susceptibility Reykjavik Study (AGES-RS) of the elderly (mean age 75±6 years) stratified by ACEIs (N = 699) or ARBs (N = 753) treatment. MAIN OUTCOMES AND MEASURES: The AGES-RS study population was stratified by ACEIs and ARBs medication use and compared for age, body mass index (BMI) (kg/m(2)), hypertension and type 2 diabetes (T2D) as well as serum levels of renin, ACE and ACE2. RESULTS: While renin and ACE levels were significantly raised in serum of individuals on ACEIs or ARBs treatments, the ACE2 levels remained unaffected. CONCLUSIONS AND RELEVANCE: Treatment with ACEIs or ARBs does not raise ACE2 levels in serum. Therefore, the present study does not support the proposed discontinuation of these medications among patients affected with COVID-19.