Is the use of RAS inhibitors safe in the current era of COVID-19 pandemic?

Park, Sungha; Lee, Hae Young; Cho, Eun Joo; Sung, Ki Chul; Kim, Juhan; Kim, Dae-Hee; Ihm, Sang-Hyun; Kim, Kwang-il; Sohn, Il-Suk; Chung, Wook-Jin; Kim, Hyeon Chang; Ryu, Sung Kee; Pyun, Wook Bum; Shin, Jinho

Antihypertensive drugs are one of the most widely used pharmacologic agent in the world and it is predominantly used in the elderly subjects. Pneumonia is the most common cause of death in the extremely old subject. During infection and its complication such as sepsis, hypotension could be exacerbated by antihypertensive drugs because homeostasis mechanisms such as sodium balance, renin angiotensin aldosterone system and/or sympathetic nervous system can be mitigated by antihypertensive drug therapy. Severe Acute Respiratory Syndrome-Coronavirus-1 and 2 viral surface protein is known to attach angiotensin converting enzyme 2 (ACE2) on the cell membrane to facilitate viral entry into the cytoplasm. Despite the theoretical concerns of increased ACE2 expression by Renin-Angiotensin-Aldosterone system (RAS) blockade, there is no evidence that RAS inhibitors are harmful during COVID-19 infection and have in fact been shown to be beneficial in animal studies. Therefore, it is recommended to maintain RAS blockade during the current corona virus pandemic.