CoViD-19 and ACE inhibitors

 

The disease is often moderate or even asymptomatic. However, severe courses can occur, usually manifesting as pneumonia. In some of the seriously ill patients, severe cardiovascular damage is also observed.

For people with heart disease, the disease - which is caused by the SARS-CoV-2 virus - thus appears to be particularly dangerous.

Angiotensin-converting enzyme 2 (ACE2) plays a major role in the body's water balance. ACE inhibitors lower blood pressure and reduce afterload - which also makes them very useful in treating heart failure disease.

ACE2 are particularly abundant in the heart and lungs. Currently, attention is focused on this enzyme because ACE2 has been identified as a functional receptor for the coronaviruses SARS-CoV and SARS-CoV-2.

It appears that the amount of ACE2 increases by taking ACE2 inhibitors in response. Thus, the body responds to inhibition of these receptors by increasing potential docking sites.

It has not yet been proven whether this mechanism promotes or exacerbates the disease!

Up-regulating ACE2 may also have benefits: The enzyme protects the heart and vasculature by cleaving angiotensin II-which promotes hypertension, edema, and tissue damage-and thereby inactivating it.

In SARS-CoV infection, ACE2 is downregulated as an antiviral protective measure: Angiotensin II can then promote severe tissue damage during infection. ACE inhibitors and sartans could therefore be helpful because they slow down angiotensin II formation or block the corresponding receptor, respectively ...

It is a fact that special attention is paid to patients with underlying cardiovascular disease in connection with covid-19 disease. Recently, experts from the U.S. Cardiac Society (ACC) considered the viral epidemic from a cardiology perspective in an official letter of recommendation. The society makes nine recommendations for managing the coronavirus epidemic.

The experts recommend that "consistent use of guideline-based therapy with plaque-stabilizing agents (statins, beta blockers, ACE inhibitors, ASS) provides additional protection for cardiac patients, and such treatment should be tailored to individual patients." Accordingly, these experts do not currently consider ACE inhibitors to be critical.

That this is a preliminary assessment is reflected in point 9 of the recommendation: here, the experts point out that little is currently known about coronavirus and physicians should be prepared for new recommendations as more information becomes available.

Source: www.pharmazeutische-zeitung.de/