Angiotensin Receptor Blockers: Pros and Cons

Are Angiotensin II Receptor Blockers (such as Losartan) dangerous or beneficial in case of COVID-19?
It looks like the answer is now clear.


March 11, 2020
We therefore hypothesise that diabetes and hypertension treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19.
Lancet Respir Med

March 3, 2020
Is the expression of ACE2 receptor in the virus targeted cells increased by the use of ACE-inhibitor/angiotensin-receptor blocker and is the patient therefore more at risk for a severe course? We need rapid epidemiological and preclinical studies to clarify this relationship. If this were the case, we might be able to reduce the risk of fatal Covid-19 courses in many patients by temporarily replacing these drugs.
British Medical Journal


3 April 2020
Among hospitalized COVID-19 patients with hypertension, inpatient use of ACEI/ARB was associated with lower risk of all-cause mortality compared with ACEI/ARB non-users.
Circulation Research

3 April 2020
…studies in animals and humans have been unable to demonstrate that upregulation of ACE2 occurs in response to ACE inhibitors or ARBs. Furthermore, experimental models of acute lung injury, including a model of SARS-CoV infection, suggest that ARBs may mitigate COVID-19 by attenuating Ang II-mediated acute lung injury by blocking AT1R. It is vitally important that clinicians, basic researchers and epidemiologists all work together to obtain, analyse and interpret data as they become available in order to fully assess the contribution, if any, of ACE inhibitors and ARBs to this pandemic
Nature Reviews Nephrology

31 March 2020
It seems Losartan can inhibit the viral macrodomain and TRPM2 so that it can interrupts the cell cycle of the virus and apoptosis, necrosis, fibrillation, and cytokine storm consequence of the COVID-19 infection. Therefore, Losartan, with preventing the induction of overexpression of the inflammatory cytokine, may decrease the severity of the disease and time of hospitalization. Presumably, Losartan with inhibition of these proteins activate the production of the interferongamma and intracellular defense against the COVID-19 virus, so enhancement resistance of person to the coronavirus.

30 March 2020
Given the equal efficacy but fewer adverse events (than ACE2 inhibitors), ARBs could potentially be a more favorable treatment option in COVID-19 patients at higher risk of developing severe forms of disease.
Mayo Clinic Proceedings

30 March 2020
Available evidence, in particular, data from human studies, does not support the hypothesis that ACEI/ARB use increases ACE2 expression and the risk of complications from COVID-19.

27 March 2020
The meta-analysis showed that ARB use has positive effects associated with morbidity and mortality of pneumonia. Interpretation Elderly (age>65) COVID-19 patients with hypertension comorbidity who are taking ARB anti-hypertension drugs may be less likely to develop severe lung disease compared to patients who take no anti-hypertension drugs.

28 January 2020
In patients lacking the systemic blood pressure for an ACE inhibitor like quinapril, an ARB such as losartan could be substituted as a first approximation, since we found it useful for West Nile virus encephalitis.
British Medical Journal

March 2008
Losartan Attenuates Ventilator-Induced Lung Injury
J Surg Res. 2008;145(1):25–32.