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/
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