key: cord-0780813-1zrwclpo
authors: Cheng, Hao; Wang, Yan; Wang, Gui‐Qiang
title: Reply to: “Reporting of all cardiac medications and their outcome in COVID‐19”
date: 2020-04-13
journal: J Med Virol
DOI: 10.1002/jmv.25868
sha: dd4fa2cf3a872dce38cb8eb93cc9f37aabacb8ca
doc_id: 780813
cord_uid: 1zrwclpo

We thank Dr. Ajay Kumar Mishra and his colleagues for their attention to our review.(1, 2) We strongly agree with them that it is inappropriate for COVID‐19 patients to discontinue ACEIs /ARBs without weighing up the pros and cons.(3, 4) Whether the RAAS inhibitors may affect the prognosis of COVID‐19 patients still needs more clinical trials to confirm. This article is protected by copyright. All rights reserved.

We thank Dr. Ajay Kumar Mishra and his colleagues for their attention to our review. 1, 2 We strongly agree with them that it is inappropriate for COVID-19 patients to discontinue ACEIs /ARBs without weighing up the pros and cons. 3, 4 Whether the RAAS inhibitors may affect the prognosis of COVID-19 patients still needs more clinical trials to confirm.

Some new data revealed that different RAAS inhibitors may have different effects on ACE2 even though their mechanisms of action are similar. 3, 5 The antihypertensive efficacy of ACEI and ARB, Ferrario et al found that blood pressure of two arms equivalently decreased after lisinopril or losartan was administrated in rats. Importantly, they also reported that the ACE2 level has a significant difference between the lisinopril group and losartan group with 4.7 and 2.8 times higher, respectively. 6 Whether RAAS inhibitors may work on ACE2 in the lungs needs further investigation.

Based on the distribution and expression of ACE2 in tissues and organs as well as the possible mechanisms that mediate the pathogenesis of COVID-19 via the classical RAAS axis, the knowledge of RAAS inhibitors and the crucial role of ACE2 in COVID-19 should be elucidated in the future study. Recent studies confirmed that a high level of Ang II has a good relationship with the severity of lung injury in COVID-19 patients. 7 ACE2 is highly expressed on type II alveolar epithelial cells, the role of ACE2 in the lungs appears to be relatively minimal

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None.

This article is protected by copyright. All rights reserved.