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Almost a year ago, I remember seeing this post here about how ACE inhibitors and ARBs may increase the risk of severe COVID-19:


It turns out, after many large observational studies, including metanalysis of these studies, that these drugs do not increase risk and decrease risk in some circumstances:


Two randomized controlled trials that suspended ACEi/ARBs in COVID-19 positive hospitalized patients such as BRACE Corona (https://pubmed.ncbi.nlm.nih.gov/33464336/) showed again no delirious impact of RAS inhibitors in the context of COVID-19 hospitalization.

Mounting in vitro and in vivo data supports the theory that these drugs may, if dosed appropriately, help in the context of COVID-19 - e.g. ARBs may be a viable treatment.

For instance, this animal study establishes a causal link between the renin-angiotensin system and COVID-19:


In the above animal study, it’s shown that the ACE2 enzyme activity itself (not as a receptor) modulates the severity of lung damage. While ARBs do not directly affect the ACE2 receptor, they likely work to stop this lung damage in a similar way (see https://www.nature.com/articles/nm1267 - for SARS, where losartan performs as well as soluble ACE2 in attenuating lung injury).

I’ve already typed too much (!) but the page above is a good catalog of these trials (de novo invitation of ARBs / renin-angiotensin modulating drugs in the context fo COVID-19)

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