Coronavirus Disease 2019 (COVID‐19) and Cardiovascular Disease: A Viewpoint on the Potential Influence of Angiotensin‐Converting Enzyme Inhibitors/Angiotensin Receptor Blockers on Onset and Severity of Severe Acute Respiratory Syndrome Coronavirus 2 Infection

he prevalence of coronavirus disease 2019 (COVID-19) has posed a great threat to people’s health worldwide, bringing a great challenges to the public healthcare systems.A recent study has confirmed that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses severe acute respiratory syndrome coronavirus (SARS-CoV) receptor angiotensin-converting enzyme 2 (ACE2) for host cell entry. 1 ACE2 expression was previously found to correlate with susceptibility to SARS-CoV infection in vitro. 2 As with SARS-CoV, higher ACE2 expression might also lead to higher risk of SARS-CoV-2 infection. See Article by Sommerstein et al.According to available clinical data, ≈15% to 30% of the COVID-19 patients are with hypertension and ≈2.5% to 15% are with coronary heart disease.[3][4][5] Angiotensinconverting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) are widely used in the treatment of these cardiovascular diseases.Interestingly, several studies have shown that ACEIs/ARBs exhibit ability to upregulate ACE2 expression in addition to their main pharmacological effect to inhibit angiotensin-converting enzyme 1 (ACE1) or block angiotensin II type 1 receptor.[6][7][8] Considering that ACE2 expression might correlate with the susceptibility to SARS-CoV-2, intake of ACEIs/ ARBs might predispose patients to the infection of SARS-CoV-2.Therefore, some cardiologists suggested that patients should discontinue ACEIs/ARBs to avoid the potential increased risk of SARS-CoV-2 infection.9 However, there is evidence demonstrating that the activation of the renin-angiotensin system (RAS) and the downregulation of ACE2 expression are involved in the pathological process of lung injury after SARS-CoV infection.10 Recently, it has been reported that serum level of angiotensin II is significantly elevated in COVID-19 patients and exhibits a linear positive correlation to viral load and lung injury.11 Activation of the RAS can cause widespread endothelial dysfunction and varying degrees of multiple organ (heart, kidney, and lung) injuries.Thus, intake of ACEIs/ARBs might probably relieve