Comment on “Should COVID-19 Concern Nephrologists? Why and to What Extent? The Emerging Impasse of Angiotensin Blockade”

Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may be harmful in patients with diabetes during COVID-19 pandemic

“…Since angiotensin 1e7 has a vasodilator effect, it has been hypothesized that it may be protective against acute respiratory distress syndrome (ARDS) occurrence in COVID-19 infection [8]. It is doubtful that the increment of angiotensin 1-7 level has a preventive effect on ARDS development.…”

“…In an experimental model, continuous infusion of angiotensin 1e7 has been shown to have a vasodilator effect only in female rats [9]. The reason why COVID-19 is less severe in women than men may be a protective effect of estrogen in premenopausal women [8]. On the other hand, ACE2 is present in many tissues such as the brain, heart, kidney, testicle, veins.…”

“…On the other hand, ACE2 is present in many tissues such as the brain, heart, kidney, testicle, veins. ACEIs and ARBs have been shown to increase the ACE2 level in the brain, heart, and kidney [8]. There is no evidence in the lung tissue that these drugs increase the ACE2 level.…”

“…Most patients with diabetes have coronary artery disease and carotid intima-media thickening even in the early stage due to hyperglycemia. Mortality is significantly higher in patients with cardiac involvement during COVID-19 infection compared to patients without cardiac involvement [8]. Increased cardiac ACE2 levels due to ACEIs and ARBs can trigger cardiac arrhythmias and myocarditis by causing the virus to easily enter the heart tissue.…”

“…As the attachment rate of the virus to cardiac ACE2 increases, patients with diabetes with COVID-19 may be more likely to die from cardiac arrhythmia. There is ACE2 activity in the rostral ventrolateral medulla in the brain stem [8]. Interestingly, the release of angiotensin 1-7 in the brain stem leads to the activation of the sympathetic nervous system [10,11].…”