Potential harmful effects of discontinuing ACE-inhibitors and ARBs in COVID-19 patients

Elife. 2020 Apr 6;9:e57278. doi: 10.7554/eLife.57278.


The discovery of angiotensin converting enzyme-2 (ACE-2) as the receptor for SARS- CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) has implicated the renin-angiotensin-aldosterone system in acute respiratory distress syndrome (ARDS) and respiratory failure in patients with coronavirus disease-19 (COVID-19). The angiotensin converting enzyme-1-angiotensin II-angiotensin AT1 receptor pathway contributes to the pathophysiology of ARDS, whereas activation of the ACE-2-angiotensin(1-7)-angiotensin AT2 receptor and the ACE-2-angiotensin(1-7)-Mas receptor pathways have been shown to be protective. Here we propose and discuss therapeutic considerations how to increase soluble ACE-2 in plasma in order for ACE-2 to capture and thereby inactivate SARS-CoV-2. This could be achieved by administering recombinant soluble ACE-2. We also discuss why and how ACEIs and ARBs provide cardiovascular, renal and also pulmonary protection in SARS-CoV-2- associated ARDS. Discontinuing these medications in COVID-19 patients may therefore potentially be harmful.

Keywords: ACE; ACE inhibitor; ACE inhibitors; ACE-2; ACEIs; ARBs; ARDS; Acute respiratory distress syndrome; COVID-19; RAAS; SARS; SARS-CoV-2; angiotensin; angiotensin receptor antagonists; angiotensin receptor blocker; angiotensin-converting enzyme-1; angiotensin-converting enzyme-2; arterial hypertension; cardiovascular; coronavirus; human biology; infection; medicine; renin-angiotensin-aldosterone system; therapy; treatment; virus.

MeSH terms

  • Angiotensin Receptor Antagonists / pharmacology
  • Angiotensin Receptor Antagonists / therapeutic use*
  • Angiotensin-Converting Enzyme 2
  • Angiotensin-Converting Enzyme Inhibitors / pharmacology
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
  • Betacoronavirus
  • COVID-19
  • Coronavirus Infections / drug therapy*
  • Coronavirus Infections / epidemiology
  • Lung / metabolism
  • Lung / virology
  • Pandemics
  • Peptidyl-Dipeptidase A / metabolism*
  • Pneumonia, Viral / drug therapy*
  • Pneumonia, Viral / epidemiology
  • Protective Agents / therapeutic use
  • Renin-Angiotensin System / drug effects
  • SARS-CoV-2


  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Protective Agents
  • ACE protein, human
  • Peptidyl-Dipeptidase A
  • ACE2 protein, human
  • Angiotensin-Converting Enzyme 2