The Heart Failure Society of America (HFSA), the American College of Cardiology (ACC), and the American Heart Association (AHA) have released a joint statement addressing concerns regarding use of renin angiotensin aldosterone system (RAAS) antagonists in patients with COVID-19. The statement advises against adding or removing any RAAS-related treatments in the setting of COVID-19, beyond actions based on standard clinical practice.
Angiotensin converting enzyme 2 (ACE2) receptors have been shown to be the entry point into human cells for SARS-CoV-2, the virus that causes COVID-19. In animal studies, both angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have been shown to upregulate ACE2 expression in the heart. Although this has not been demonstrated in human studies or in the setting of COVID-19, potential upregulation of ACE2 by ACE inhibitors or ARBs has resulted in a speculation of potential increased risk for COVID-19 infection in patients who are taking these medications.
Currently there are no experimental or clinical data demonstrating beneficial or adverse outcomes with background use of ACE inhibitors, ARBs or other RAAS antagonists in COVID-19. The HFSA, ACC, and AHA recommend continuation of RAAS antagonists for patients who are currently prescribed them for treatment of heart failure, hypertension, or ischemic heart disease. In the event patients with cardiovascular disease are diagnosed with COVID-19, individualized treatment decisions should be made according to each patient’s hemodynamic status and clinical presentation. Clinicians are advised not to add or remove any RAAS-related treatments, beyond actions based on standard clinical practice.
American Heart Association (AHA). HFSA/ACC/AHA statement addresses concerns re: using RAAS antagonists in COVID-19. March 17, 2020. Available at: click here. Accessed March 18, 2020.