COVID-19 and RAAS inhibitors: the controversy continues

Abstract

Since the beginning of the recent SARS-COVID pandemic, renin-angiotensin-aldosterone system inhibitors (RAASIs) have been in the center of controversy. The virus interacts with angiotensin converting enzyme 2 (ACE2) receptors in the lungs at the initial step of its entry in to the body. Theoretically, therapeutic use of RAASIs may aggravate the severity of lung damage by increasing ACE2 expression in the lung tissues. Given the widespread use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers among patients with high blood pressure and other non-communicable diseases in Sri Lanka, some guidance on the use of these drugs in patients with Corona virus Disease 2019 (COVID-19) is needed. At present there isn't any credible evidence to support the withdrawals from those who are on regular treatment with these drugs. We present the available data on the subject while awaiting the results of the observational studies that is being conducted with RAAIs in patients with COVID-19.