Potential harmful effects of discontinuing ACE-inhibitors and ARBs in COVID-19 patients

  1. Gian Paolo Rossi  Is a corresponding author
  2. Viola Sanga  Is a corresponding author
  3. Matthias Barton  Is a corresponding author
  1. University of Padova, Italy
  2. University of Zurich, Switzerland


The discovery that SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) RNA binds to the angiotensin converting enzyme (ACE)-2, which is highly expressed in the lower airways, explained why SARS-CoV-2 causes acute respiratory distress syndrome (ARDS) and respiratory failure. After this, news spread that ACEis and ARBs would be harmful in SARS-CoV-2-infected subjects. To the contrary, compelling evidence exists that the ACE-1/angiotensin(Ang)II/ATR-1 pathway is involved in SARS-CoV-2-induced ARDS, while the ACE-2/Ang(1-7)/ATR2/MasR pathway counteracts the harmful actions of AngII in the lung. A reduced ACE-1/ACE-2 ratio is, in fact, a feature of ARDS that can be rescued by human recombinant ACE-2 and Ang(1-7) administration, thus preventing SARS-CoV-2-induced damage to the lung. Based on the current clinical evidence treatment with ACE-inhibitors I (ACEis) or angiotensin receptor blockers (ARBs) continues to provide cardiovascular and renal protection in patients diagnosed with COVID-19. Discontinuing these medications may therefore be potentially harmful in this patient population.

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Author details

  1. Gian Paolo Rossi

    Department of Medicine-DIMED - Hypertension Unit, University of Padova, Padova, Italy
    For correspondence
    Competing interests
    No competing interests declared.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-7963-0931
  2. Viola Sanga

    Department of Medicine-DIMED - Hypertension Unit, University of Padova, Padova, Italy
    For correspondence
    Competing interests
    No competing interests declared.
  3. Matthias Barton

    University of Zurich, Zurich, Switzerland
    For correspondence
    Competing interests
    Matthias Barton, Senior Editor, eLife.


The authors declare that there was no funding for this work.

Reviewing Editor

  1. Mone Zaidi, Icahn School of Medicine at Mount Sinai, United States

Publication history

  1. Received: March 26, 2020
  2. Accepted: April 3, 2020
  3. Accepted Manuscript published: April 6, 2020 (version 1)
  4. Accepted Manuscript updated: April 8, 2020 (version 2)
  5. Accepted Manuscript updated: April 9, 2020 (version 3)
  6. Accepted Manuscript updated: April 15, 2020 (version 4)
  7. Version of Record published: May 4, 2020 (version 5)
  8. Version of Record updated: May 6, 2020 (version 6)


© 2020, Rossi et al.

This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.


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  1. Gian Paolo Rossi
  2. Viola Sanga
  3. Matthias Barton
Potential harmful effects of discontinuing ACE-inhibitors and ARBs in COVID-19 patients
eLife 9:e57278.

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    C. Liu’s lab was supported by grants from the Public Health Science and Technology Project of Shenyang (grant: 22-321-32-18); Y. Yang’s laboratory was supported by the National Natural Science Foundation of China (grant: 81874301), the Fundamental Research Funds for Central University (grant: DUT22YG122), and the Key Research project of ‘be Recruited and be in Command’ in Liaoning Province (2021JH1/10400050).

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    Funding: RD is supported by the National Institute of General Medical Sciences of the National Institutes of Health (NIH) (R35-GM124836) and the National Heart, Lung, and Blood Institute of the NIH (R01-HL139865 and R01-HL155915).