Renin-Angiotensin System Inhibition in Cardiovascular Patients at the Time of COVID19: Much Ado for Nothing? A Statement of Activity from the Directors of the Board and the Scientific Directors of the Italian Society of Hypertension

Guido Iaccarino; Claudio Borghi; Arrigo F G Cicero; Claudio Ferri; Pietro Minuz; Maria Lorenza Muiesan; Paolo Mulatero; Giuseppe Mulè; Giacomo Pucci; Massimo Salvetti; Carmine Savoia; Leonardo Alberto Sechi; Massimo Volpe; Guido Grassi

doi:10.1007/s40292-020-00380-3

Renin-Angiotensin System Inhibition in Cardiovascular Patients at the Time of COVID19: Much Ado for Nothing? A Statement of Activity from the Directors of the Board and the Scientific Directors of the Italian Society of Hypertension

High Blood Press Cardiovasc Prev. 2020 Apr;27(2):105-108. doi: 10.1007/s40292-020-00380-3. Epub 2020 Apr 7.

Authors

Affiliations

¹ Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
² Department of Medicine and Surgery Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
³ Department of Clinical Medicine, Public Health, Life and Environment Sciences, University of Aquila, L'Aquila, Italy.
⁴ Department of Medicine, University of Verona, Verona, Italy.
⁵ Dept of Clinical & Experimental Sciences, University of Brescia-Medicina 2, ASST Spedali Civili Brescia, Brescia, Italy.
⁶ Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Turin, Italy.
⁷ Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Unit of Nephrology and Hypertension, University of Palermo, Palermo, Italy.
⁸ Section of Internal Medicine Terni, Department of Medicine, University of Perugia, Terni, Italy.
⁹ Clinical and Molecular Medicine Department, Sapienza University of Rome, Rome, Italy.
¹⁰ Department of Medical Area, University of Udine, Udine, Italy.
¹¹ Division of Cardiology, Department of Clinical and Molecular Medicine, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy.
¹² IRCCS Neuromed, Pozzilli, IS, Italy.
¹³ Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. guido.grassi@unimib.it.

Abstract

Cardiovascular diseases, in particular hypertension, as well as the cardiovascular treatment with Renin-Angiotensin System inhibitors such as Angiotensin Converting Enzyme (ACE) inhibitors and Angiotensin Receptor Blockers (ARBs), are claimed once again as mechanisms of Severe Acute Respiratory Syndrome (SARS) during the COVID-19 outbreak due to Cov-2 epidemics. In vitro studies are available to support the eventual role of ACE inhibitors and ARBs in both the promotion and antagonism of the disease. The available literature, indeed, presents contrasting results, all concentrated in experimental models. Evidence in humans is lacking that those mechanisms are actually occurring in the present COVID-19 outbreak. Here we present the reasoned statement of the Italian Society of Hypertension to maintain ongoing antihypertensive treatments. Furthermore, the Italian Society of Hypertension presents its own initiative to investigate the issue using an online questionnaire to collect relevant data in human disease.

Keywords: COVID-19; cardiovascular diseases; hypertension; infection; outcomes.

Publication types

Practice Guideline

MeSH terms

Angiotensin Receptor Antagonists* / adverse effects
Angiotensin Receptor Antagonists* / therapeutic use
Angiotensin-Converting Enzyme Inhibitors* / adverse effects
Angiotensin-Converting Enzyme Inhibitors* / therapeutic use
Antihypertensive Agents* / adverse effects
Antihypertensive Agents* / therapeutic use
Betacoronavirus
COVID-19
Cardiovascular Diseases / complications
Coronavirus Infections* / complications
Humans
Hypertension / complications
Hypertension / drug therapy*
Italy
Pandemics*
Pneumonia, Viral* / complications
Renin-Angiotensin System* / drug effects
SARS-CoV-2

Substances

Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Antihypertensive Agents