Letter to the editor: Anti-RAS drugs and SARS-CoV-2 infection

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To the Editor:rnCoronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly throughout the world.It has already posed a great threat to global public health security.Angiotensin-converting enzyme 2 (ACE2) has been identified as the major receptor of SARS-CoV-2.In addition, ACE2 is well-known as a counter-regulator of the renin-angiotensin system (RAS) and plays a key role in cardiovascular disease, especially hypertension.Thus, we are facing an important question: are patients with hypertension at increased risk of SARS-CoV-2 infection? The latest view from Fang et al.in The Lancet Respiratory Medicine1 was that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin Ⅱ type-Ⅰ receptor blockers (ARBs) can result in the upregulation of ACE2, which may facilitate SARS-CoV-2 infection.They further suggested that antihypertensive calcium channel blockers (CCBs) can be a suitable alternative treatment for patients with hypertension or diabetes,because there is no evidence that CCBs can increase ACE2 expression or activity.Meanwhile, other literatures have also reported that patients who take ACEIs and ARBs may be at increased risk of severe disease outcomes due to SARS-CoV-2 infections2.
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