Controversies of Renin-Angiotensin System Inhibition During the COVID-19 Pandemic

Nat Rev Nephrol. 2020 Jun;16(6):305-307. doi: 10.1038/s41581-020-0279-4.


The current COVID-19 pandemic is associated with unprecedented morbidity and mortality. Early reports suggested an association between disease severity and hypertension but did not account for sources of confounding. However, the responsible virus — SARS-CoV-2 — gains entry to host cells via angiotensin-converting enzyme 2 (ACE2), highlighting the need to understand the relationship between the virus and the renin–angiotensin system (RAS) and how this might be affected by RAS inhibitors.

MeSH terms

  • Betacoronavirus / drug effects*
  • Coronavirus Infections / drug therapy*
  • Enzyme Inhibitors / therapeutic use*
  • Humans
  • Pandemics
  • Peptidyl-Dipeptidase A / metabolism
  • Pneumonia, Viral / drug therapy*
  • Renin-Angiotensin System / drug effects*
  • Virus Internalization / drug effects


  • Enzyme Inhibitors
  • Peptidyl-Dipeptidase A
  • angiotensin converting enzyme 2

Supplementary concepts

  • COVID-19
  • COVID-19 drug treatment
  • severe acute respiratory syndrome coronavirus 2