Treatment with ACE-inhibitors is associated with less severe disease with SARS-Covid-19 infection in a multi-site UK acute Hospital Trust

Daniel Bean; Zeljko Kraljevic; Thomas Searle; Rebecca Bendayan; Andrew Pickles; Amos Folarin; Lukasz Roguski; Kawsar Noor; Anthony Shek; Kevin o'gallagher; Rosita Zakeri; Ajay Shah; James Teo; Richard JB Dobson

A tentative favourable association of ACE-inhibitors with less severe early outcomes is suggested by this study. A putative mechanism could be reduced RAS activation in patients on ACE-inhibitors, which is considered protective in Acute Respiratory Distress Syndrome, ARDS. 3 Furthermore, elevation of ACE2 also reduces RAS activation and is protective in acute lung injury, 19 including in ARDS of SARS1 infection. 20 In summary, based on these early results and the absence of any evidence suggesting harm, patients on treatment with ACE-inhibitors should continue these drugs during their COVID-19 illness as per current guidelines. 21 Active research is merited on whether ACE inhibition or enhancement of ACE2 may have a therapeutic role in severe COVID-19 disease.