The expression of ACE 2 is substantially increased in patients with hypertension and/or diabetes treated with ACE inhibitors or ARBs. Both ACE inhibitors and ARBs are cornerstone therapeutics for hypertension, chronic kidney disease, diabetic kidney disease and heart failure. At the start of the COVID-19 epidemic it was speculated that these drugs might facilitate viral entry to the lung, although there were no clinical data to support this interesting hypothesis and it was equally plausible that ARBs in particular may convey some protection from COVID-19 infection. In the absence of data, there was a call for calm reflection on how basic science may inform clinical practice in the face of a global pandemic (4).
Early on in the pandemic, most professional societies (e.g. European Society of Cardiology, UK Renal Association advised against stopping the ACE inhibitors or ARBs in patients without symptoms of COVID-19. Observational data now support that there is no evidence that these drugs increase risk of COVID-19 infection (5).
Recommendations were less clear for patients with proven COVID-19 but recent reports suggest that these drugs are not associated with worse outcomes in COVID-19 (6).
Therefore, unless there is a clear reason to discontinue these ACE inhibitors or ARBs in patients with COVID-19 (hypotension, severe acute kidney injury) it appears reasonable to continue them. In patients who do discontinue these drugs in the setting of severe acute illness it is important to plan when to recommence therapy when there a strong evidence-based indication for their use.