Abstract

ACE INHIBITORS AND ANGIOTENSIN RECEPTOR BLOCKERS REDUCE THE COMPLICATIONS ASSOCIATED WITH COVID-19 INFECTION

Sunil J. Wimalawansa,* MD, Ph.D., MBA, FRCPath, DSc

Abstract

Although COVID-19 can infect any human, individuals with vitamin D deficiency and consequently having a weaker innate immune system are at the most risk of developing complications and death. In more than 80% of infected people, the disease is asymptomatic or mild, but in those with severe vitamin D deficiency, COVID-19 can be detrimental. Less than 10% of those affected by COVID-19 (SARS-CoV-2) develop severe lower respiratory tract syndrome and other complications. The elderly and those with comorbidities, such as diabetes mellitus, obesity, hypertension, and cardiovascular and renal disorders, have an inherently lower angiotensin-converting enzyme-2 (ACE-2) concentration, increasing the risk of severe complications, including death. Vitamin D deficiency weakens the innate immune system and delays immune responses, allowing exponential viral growth and spread and overacting the inflammatory cytokines and the renin-angiotensin-aldosterone hormonal system (RAS). The regular consumption of ACE inhibitors or angiotensin receptor blockers (ARBs) that are routinely used for hypertension and to protect kidneys reduces the enzyme renin and final product of the RAS pathway, angiotensin-II. At the same time, increase the expression of ACE-2 that is protective against the viral spread. Overall evidence supports that ACE inhibitors and ARBs, reducing the risk of COVID-19, associated complications, and deaths.

Keywords: Angiotensin; cardiovascular; coronavirus; endocrine; inflammation; innate immunity; vitamin D; pandemic; Renin; SARS-CoV-2.