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2020年3月22日 (日)

Angiotensin II receptor, ACEi, ARB and COVID19 / ACE阻害薬やARBとCOVID19


Hypertension, adult men and smokers are well known risk factors for Coronavirus COVID19.
Because I described a report about ARBs and published a paperback about medicines, RAAS system is familiar to me.

SARS is also caused by coronavirus. At that time, the researchers studied that coronavirus binds to the angiotensin II receptor (ACEII-R) appearing surface of lung cells. It was also reported that only few ratio of hypertensive people in Wuhan had suitable treatment. Hypertension and diabetes may affect ACEII-R expression in the lungs.

There are reports that ACEII-R numbers are increasing in hypertensives and smokers and relate to how cell differentiate and mature.

Drugs such as ACE inhibitors and ARBs are used to treat hypertension. It is more expensive than diuretics and calcium channel blockers (CCBs). It is known to have cardioprotective effects as well as high blood pressure.

ACE inhibitors have the well-known side effect of cough because bradykinin is increased in the lungs. This indicates that ACEII-R is abundant in the lung.


There are two hypotheses in addition to antihypertensive effect by the agants.

1. ARB covers ACEII-R to which coronavirus binds. Putting it simply, ARBs seems to be effective against COVID19 attachment and entering into cells.

2. On the other hand, taking ACE inhibitors or ARBs decreases angiotensin II, so cells will increase ACEII-R and try to respond to small amounts of angiotensin II. In other words, the increasing ACEII-R may be more harmful.


In order to resolve this contradiction, there are several strategies with artificial ACEII-R to create medicines.

The European Society of Cardiology recently issued a statement saying "ACE inhibitors and ARBs actually protect the lungs in the current clinical situation, thus do not stop taking the agents. Don't forget the function that the medicines protect cardiopulmonary function''.

I know that large amounts of inexpensive diuretics and CCBs are used to treat hypertension to reduce medical costs. It has been reported that ARB, which is popular in Japan, is used only in a small percentage in the world.

I guess that the low damage to COVID19 in Japan may be due to the heavy use of ARB. In Japan, ARB can be used at low cost through medical insurance by all doctors. In addition, smoking cessation has been progressing.

Above all, I think that the most essential and necessary factor is that the usual treatment of high blood pressure and diabetes has improved the lung environment.

In that regard, I have been telling my patients “taking ARBs may exert protective effect to your lungs in such situation”. I still think that is correct, because antihypertensive treatment itself is significantly beneficial.

Because Japan is very close to China and there was also no shore of invisible coronavirus Covid19, we must have allowed many coronavirus invasions as other countries.

COVID19 and the angiotensin receptor will be studied in the future. A sub-analysis of what medications hypertensive patients were taking will be keenly investigated.

The only thing that can be said is that it is important to properly treat high blood pressure and to quit smoking in order to reduce the severity of coronavirus.

Thank you for reading.











European Society of Cardiology欧州心臓病学会は、つい最近「まだヒトでは確認されていないものの、現実の臨床の現場ではACE阻害薬やARBは肺を守ってくれているので、内服を止めないように。降圧剤による心肺機能保護効果をわすれないように。」との声明をだしました。







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