The correct answer is:

Patients receiving angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) should continue treatment with these agents.

Educational Objective:

Discuss management of ACE inhibitors and ARBS during a viral infection such as COVID-19 that uses ACE2 as its receptor.

Key Point:

Multiple guidelines recommend that patients receiving angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) should continue treatment with these agents during a COVID-19 infection.

Explanation:

Angiotensin-converting enzyme 2 (ACE2) is a receptor for SARS-CoV-2 [130], and renin-angiotensin-aldosterone system inhibitors can increase ACE2 levels. Although patients with cardiovascular disease, hypertension, and diabetes may have a more severe clinical course in the setting of infection with SARS-CoV-2, there is no evidence to support an association with these agents. In addition, stopping these agents in some patients may exacerbate comorbid cardiovascular or kidney disease and lead to increased mortality.

On a different note: Patients with COVID-19 who are receiving immunomodulatory agents are at increased risk for severe disease. It is recommended that the decision to discontinue these agents is made on a case-by-case basis. A positive COVID-19 test is important because if COVID-19 is not the infecting agent, there may not be a reason to discontinue these important medications.

Review: In humans, ACE2 receptors are distributed over the tongue, oropharynx, bronchi, bronchioles, esophagus, and intestines. Follow these 3 links to publications that describe this receptor in the human body in more details.

High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa

Angiotensin Receptors: Structure, Function, Signaling and Clinical Applications

How the Coronavirus Could Take Over Your Body (Before You Ever Feel It)

References:

Patients taking ACE-i and ARBs who contract COVID-19 should continue treatment, unless otherwise advised by their physician. Statement from the American Heart Association, the Heart Failure Society of America and the American College of Cardiology. (Accessed March 27, 2020).

ESH Statement on COVID-19. European Society of Hypertension. (Accessed March 27, 2020).

A statement from the International Society of Hypertension on COVID-19. International Society of Hypertension. (Accessed March 27, 2020).

Position Statement of the ESC Council on Hypertension on ACE-Inhibitors and Angiotensin Receptor Blockers (Accessed March 27, 2020).

Xu, H., Zhong, L., Deng, J. et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa.  Int J Oral Sci12, 8 (2020).

Singh KD, Karnik KS. Angiotensin Receptors: Structure, Function, Signaling and Clinical Applications. J Cell Signal. 2016 June ; 1(2): . doi:10.4172/jcs.1000111.