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Preventing a covid-19 pandemic

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m810 (Published 28 February 2020) Cite this as: BMJ 2020;368:m810

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ACE inhibitors and ARBs are not a risk factor for fatal Covid-19 Re: Preventing a covid-19 pandemic

Dear Editor,

Rami Sommerstein's letter created unwarranted panic in hypertensive patients taking ACE inhibitors and ARBs.

I would like to remind readers that ACE inhibitors and ARBs are associated with improvements in pneumonia-related outcomes as reported in a retrospective study of 30 thousand elderly patients (over 65 years) hospitalized for pneumonia (1).

Mice infected with avian influenza A H5N1 virus (3) and mice infected with SARS-COV (4) treated with losartan showed alleviated lung edema and improved lung histopathology.

Liu discovered the markedly increased level of Angiotensin II in the plasma samples from 2019-nCoV infected patients and suggests that ARB drugs may be used as treatment for ICU patients infected with 2019-nCoV. (5).

As a nephrologist, I suggest caution in the use of ARBs in patients suffering from the risk of acute renal failure, but these studies that suggest a protective role of ARBs in pneumonia in general and particularly in viral pneumonia cannot be ignored.

References
1 Eric M. Mortensen, Brandy Nakashima et all. Population-Based Study of Statins,AngiotensinII Receptor Blockers, and Angiotensin-Converting Enzyme Inhibitors on Pneumonia-Related Outcomes. Clinical Infectious Diseases 2012
2 Yiwu Yan, Xiao Li, Chang Li. Angiotensin II receptor blocker as a novel therapy in acute lung injury inducedby avian influenza A H5N1 virus infection in mouse. Science China 2015
3 Zhen Zou, Yiwu Yan et al. Angiotensin-converting enzyme 2 protects from lethal avian influenza A H5N1 infections. Nature communications 2014
4 Yingxia Liu, Yang Yang et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Schience China 2020

Competing interests: No competing interests

10 March 2020
Ottavio Amatruda
freelance nephrologist specialist
VIA MONTE ROSA 9 21020 Casciago (VA) Italy