The Renin-Angiotensin-Aldosterone System and Coronavirus Disease 2019

Eliecer Coto, Pablo Avanzas, Juan Gómez, Eliecer Coto, Pablo Avanzas, Juan Gómez

Abstract

The renin-aldosterone-angiotensin system (RAAS) plays an important role in the pathogenesis of coronavirus disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Angiotensin-converting enzyme 2 (ACE2) is the cellular receptor for SARS-CoV-2 and the host's expression of this membrane-bound protein could affect susceptibility to infection. The RAAS is an important regulator of cardiovascular physiology and ACE2 has an essential role. People with hypertension and other traits have shown to have an imbalance in ACE/ACE2 levels and reduced levels of ACE2 could enhance the risk of adverse outcome in patients with COVID-19. It has been hypothesised that the RAAS may mediate the interplay between cardiovascular disease and COVID-19 severity. Evidence shows that antihypertensive drugs that target the RAAS have no significant effect on the risk of infection and disease outcome. Variations in RAAS genes have been associated with the risk of developing hypertension and cardiovascular disease and could partly explain the heterogenous response to SARS-CoV-2 infection. This article explores the interplay between the RAAS and COVID-19, with emphasis on the possible relationship between genetic variations and disease severity.

Keywords: COVID-19; SARS-CoV-2; angiotensin II receptor inhibitors; angiotensin-converting enzyme inhibitors; angiotensin-converting enzyme polymorphisms; cardiovascular comorbidities; coronavirus; renin–angiotensin–aldosterone system.

Conflict of interest statement

Disclosure: This work was supported by a grant from the Spanish Plan Nacional de Investigación Científica, Desarrollo e Innovación Tecnológica, Ministerio de Economía y Competitividad and a grant from the European Regional Development Fund (ISCIII-Red de Investigación Renal-REDINREN RD16/9/5 [EC]). The authors have no other conflicts of interest to disclose.

Copyright © 2021, Radcliffe Cardiology.

Figures

Figure 1:. COVID-19 Patients Who Required Hospitalisation…
Figure 1:. COVID-19 Patients Who Required Hospitalisation During the First Wave of the Pandemic Between March and July 2020 in Asturias, Showing Severity and Deaths per Age Range
Figure 2:. The Renin–Angiotensin–Aldosterone System
Figure 2:. The Renin–Angiotensin–Aldosterone System
Figure 3:. Rate of Comorbidities Among COVID-19…
Figure 3:. Rate of Comorbidities Among COVID-19 Patients Hospitalised in the Region of Asturias

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Source: PubMed

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