Renin-Angiotensin-System (RAS) und COVID-19 – Zur Verordnung von RAS-Blockern

Abstract

Twenty years ago, an enzyme homologous to the previously known angiotensin-converting enzyme (ACE) was identified, and subsequently named ACE2. In the renin-angiotensin system (RAS), ACE2 has counter-regulatory functions against the classical effector peptide angiotensin II, for example in blood pressure regulation and cardiovascular remodeling. However, ACE2 provides an initially unexpected interesting link between virology and cardiovascular medicine. That is, ACE2 represents the binding receptor for the cellular uptake of SARS-CoV and SARS-CoV-2 viruses. Thus, ACE2 is relevant for COVID-19. In this context, it was suspected that therapy with RAS blockers might promote transmission and complications of COVID-19 by upregulation of ACE2 expression. The aim of this short review is, to describe the link between the RAS, particularly ACE2, and COVID-19. Based on our analysis and evaluation of the available findings, we justify our conclusion: important drugs such as ACE inhibitors and angiotensin receptor blockers should continue to be prescribed according to guidelines to stable patients in the context of the COVID-19 pandemic. In der Forschung zur SARS-Epidemie (2003) ergab sich schon damals unerwartet eine neue Verbindung zwischen Virologie und Herz-Kreislauf-Medizin – eine Erkenntnis, die wieder aktuell geworden ist. Denn inzwischen ist bekannt, dass ACE2 auch den Bindungsrezeptor für das neue Virus der COVID-19-Infektion, SARS-CoV-2, darstellt. Sind Medikamente wie ACEI und ARB nun riskant? Der Beitrag erläutert die Zusammenhänge und die Relevanz für den Praktiker.