COVID-19 and arterial hypertension: is there evidence to suspend renin-angiotensin-aldosterone system blockade?
PDF (Español (España))


COVID-19, Angiotensin Converting Enzyme, Angiotensin Converting Enzyme Inhibitors, Renin-Angiotensin-Aldosterone System

How to Cite

Villanueva Bendek I, Ramírez Marmolejo R, Montejo JD, Rodelo Ceballos J, Puello González L, Vélez Verbel M, Gómez Franco L. COVID-19 and arterial hypertension: is there evidence to suspend renin-angiotensin-aldosterone system blockade?. Rev. Colomb. Nefrol. [Internet]. 2020 Apr. 24 [cited 2023 Apr. 1];7(Supl.2). Available from:


The new coronavirus SARS-CoV-2, which causes the disease COVID-19, has a high mortality in patients with cardiovascular diseases, diabetes and hypertension, disorders that share the underlying pathophysiology related to the renin-angiotensin system (RAS). SARS-CoV-2 uses the membrane protein angiotensin I and converts angiotensin converting enzyme type 2 (ACE2) into a cellular entry receptor, therefore, RAS, regulated by ACE and ACE2, can be altered in COVID-19 patients. However, it is not yet clear whether the use of antihypertensive drugs ACE2 inhibitors and angiotensin II receptor blockers could potentiate the damage caused by the virus or counteract its effect, especially in the lungs. The challenge is compounded by the exaggerated information published in different scientific journals, which could lead to inappropriate actions, so it is important to quickly differentiate the true epidemic from false hypotheses, which could lead to potentially harmful medical behaviors.
PDF (Español (España))


Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential Effects of Coronaviruses on the Cardiovascular System: A Review. JAMA Cardiol . 2020;5(7):831-40.

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus- Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9.

Onder G, Rezza G, Brusaferro S. Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy. Jama. 2020;323(18):1775-6.

Livingston E, Bucher K. Coronavirus Disease 2019 (COVID-19) in Italy. Jama. 2020323(14):1334.

Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet. 2020;395(10223):470-3.

Adams JG, Walls RM. Supporting the Health Care Workforce during the COVID-19 Global Epidemic. JAMA. 2020;323(15):1439-1440.

Phelan AL, Katz R, Gostin LO. The Novel Coronavirus Originating in Wuhan, China: Challenges for Global Health Governance. JAMA. 2020;323(8):709-10.

Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475-81. S2213-2600(20)30079-5

Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382:1708-20.

Zhang J, Dong X, Cao Y, Yuan Y, Yang Yn, Yan Yn, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020;57(7):1730-41.

The novel Coronavirus Pneumonia Emergency Response Epidemiological Team. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID 19) - China, 2020. China CDC Weekly. 2020;2(8):113-22.

Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis. Int J Infect Dis. 2020;94:91-5.

Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019(COVID-19) outbreak in China : Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020.

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62.

Fauci AS, Lane HC, Redfield RR. Covid-19 - Navigating the Uncharted. N Engl J Med. 2020;382(13):1268-9

Kuster GM, Pfister O, Burkard T, Zhou Q, Twerenbold R, Haaf P, et al. SARS-CoV2: should inhibitors of the renin-angiotensin system be withdrawn in patients with COVID-19? Eur Heart J. 2020;41(19):1801-3.

Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol. 2020;109:531-8.

Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020;5(7):811-8.


Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk Factors Associated with Acute Respiratory Distress Syndrome and Death in Patients with Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-43.

Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med. 2020;8(4):e21.

Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579(7798):270-3.

Harmer D, Gilbert M, Borman R, Clark KL. Quantitative mRNA expression profiling of ACE 2, a novel homologue of angiotensin converting enzyme. FEBS Lett. 2002;532(1-2):107-10.

Lo KB, McCullough PA, Rangaswami J. Antihypertensive drugs and risk of COVID-19? Lancet Respir Med. 2020;8(5):30156-9.

Imai Y, Kuba K, Rao S, Huan Y, Guo F, Guan B, et al. Angiotensin-converting enzyme 2 protects from severe acute lung failure. Nature. 2005;436:112-6.

Rice GI, Thomas DA, Grant PJ, Turner AJ, Hooper NM. Evaluation of angiotensin-converting enzyme (ACE), its homologue ACE2 and neprilysin in angiotensin peptide metabolism. Biochem J. 2004;383(Pt 1):45-51.

Kuba K, Imai Y, Rao S, Gao H, Guo F, Guan B, et al. A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus- induced lung injury. Nat Med. 2005;11(8):875-9.

Burrell LM, Johnston CI, Tikellis C, Cooper ME. ACE2, a new regulator of the renin-angiotensin system. Trends Endocrinol Metab. 2004;15(4):166-9.

Vaduganathan M, Vardeny O, Michel T, McMurray J, Pfeffer M, Solomon SD. Renin–Angiotensin–Aldosterone System Inhibitors in Patients with Covid-19. N Engl J Med. 2020;382(17):1653-9.

Khan A, Benthin C, Zeno B, Albertson TE, Boyd J, Christie JD, et al. A pilot clinical trial of recombinant human angiotensin- converting enzyme 2 in acute respiratory distress syndrome. Crit Care. 2017;21(1):234.

Liu Y, Huang F, Xu J, Yang P, Qin Y, Cao M, et al. Anti-hypertensive Angiotensin II receptor blockers associated to mitigation of disease severity in elderly COVID-19 patients. medRxiv. 2020.

Zhang H, Penninger JM, Li Y, Zhong N, Slutsky AS. Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive Care Med. 2020;46(4):586-90.

Sociedad Europea de Cardiología. Declaración de posición del Consejo ESC sobre Hipertensión en inhibidores de la ECA y bloqueadores de los receptores de angiotensina. 2020 [citado marzo 20 2020]. Disponible en: hypertension-says-ace-i-and-arbs-do-not-increase-covid-19-mortality.

Asociación americana del corazón. La declaración HFSA/ACC/AHA aborda las preocupaciones relacionadas con el uso de antagonistas de RAAS en COVID-19. 2020 [citado marzo 20 2020]. Disponible en: arbs-who-contract-covid-19-should-continue-treatment-unless-otherwise-advised-by-their-physician.

Sociedad Española de Cardiologia. No hay evidencia clínica ni científica para suspender tratamientos de IECA y ARA debido a la infección por COVID-19. comunicados-oficiales/11446-no-hay-evidencia- clinica-ni-cientifica-para-suspender-tratamientos-de-ieca-y-ara-debido-a-la-infeccion-por-covid-19

World Health Organization (WHO). Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). Geneva: WHO; 2020 [consultado marzo 10 2020] Disponible en on-covid-19-final-report.pdf.

Lai K, Shen H, Zhou X, Qiu Z, Cai S, Huang K, et al. Clinical Practice Guidelines for Diagnosis and Management of Cough-Chinese Thoracic Society (CTS) Asthma Consortium. J Thorac Dis. 2018;10(11):6314-51.

Dykewicz MS. Cough and angioedema from angiotensin-converting enzyme inhibitors: New insights into mechanisms and management. Curr Opin Allergy Clin Immunol. 2004;4(4):267-70.

Irwin RS, Madison JM. The diagnosis and treatment of cough. N Engl J Med. 2000;343(23):1715-21. NEJM200012073432308

Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, et al. Diagnosis and Management of Cough Executive Summary: ACCP Evidence-Based Clinical Practice Guidelines. Chest. 2006;129(Suppl 1):1S-23S. chest.129.1_suppl.1S

Epstein M, Reaven NL, Funk SE, McGaughey KJ, Oestreicher N, Knispel J. Evaluation of the Treatment Gap Between Clinical Guidelines and the Utilization of Renin-Angiotensin-Aldosterone System Inhibitors. Am J Manag Care. 2015;21(Suppl 11):S212-20.

No national or foreign publication may partially or totally reproduce or translate Revista Colombiana de Nefrología articles or abstracts without prior written permission from the journal’s Editorial Board.




Download data is not yet available.