key: cord-333164-1iiwhmkm
authors: Singh, Awadhesh Kumar; Gupta, Ritesh; Misra, Anoop
title: Reply to the Letter of Mahajan and Gaur in response to the article: Comorbidities in COVID-19: outcomes in hypertensive cohort and controversies with renin angiotensin system blockers (Singh et al.)
date: 2020-05-23
journal: Diabetes Metab Syndr
DOI: 10.1016/j.dsx.2020.05.030
sha: 
doc_id: 333164
cord_uid: 1iiwhmkm

nan

Reply to the Letter of Mahajan and Gaur in response to the article: Comorbidities in COVID-19: outcomes in hypertensive cohort and controversies with renin angiotensin system blockers (Singh et This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Comorbidities in COVID-19: outcomes in hypertensive cohort and controversies with renin angiotensin system blockers (Singh et al.) .

Dear Sir,

We appreciate the keen interest taken by Drs. Mahajan and Gaur for sending a correspondence in response to our article titled "Comorbidities in COVID-19:

outcomes in hypertensive cohort and controversies with renin angiotensin system blockers" [1] .

Although the authors are in agreement with the findings in general, however they have raised two questions in the correspondence. We agree and that angiotensinconverting enzyme inhibitors do not increase angiotensin II, while angiotensinreceptor blockers have the potential to increase it. However, the hypothesis that the interaction of angiotensin converting enzyme-2 (ACE-2) with angiotensin II could lead to a conformational change in the receptor binding domain of ACE2 is not unfounded and has been put forth in the study on the X-Ray structure of ACE-2 [2] . With regards to other query about the purported protection of lung injury by the renin angiotensin system blockers(RASBs), we humbly inform that it has already been dealt with a great detail, which authors seems to have overlooked.

Similarly, the figures in our article has much more detailed information on the interaction of renin angiotensin system blockers (RASB), ACE-2 and coronavirus infectious disease 2019 (COVID-19).

We would like to reiterate again, that the benefit or harm with RASBs in COVID-19 is still a subject of debate and data at this point of time suggest a clinical equipoise. Some studies have shown a purported harm [3, 4] , while some others have shown benefit [5] ; the reason why we discussed both these issues in detail.

However, we do not recommend to stop the RASB in patient with COVID-19.

Ritesh Gupta

Anoop Misra

Comorbidities in COVID-19: outcomes in hypertensivecohort and controversies with renin angiotensin system blockers

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Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease

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Early treatment of 1061 COVID-19 patients with hydroxychloroquine and azithromycin

Association of Inpatient Use of Angiotensin Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers with Mortality Among Patients With Hypertension Hospitalized With COVID-19