Abstract
Background and Objective: The cardiovascular diseases are the most frequent comorbidities of Covid-19 infection. The severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) employs the angiotensin converting enzyme 2 (ACE2) receptor to invade cells. Angiotensin receptor blockers (ARBs) do not directly interact with ACE2 receptor, but they could affect course of Covid-19 infection because they increase expression of ACE2 and this could offer more binding sites for the virus. However, this could support cardiopulmonary protective effects of the ACE2/Ang-(1-7)/Mas axis. Also, sensitivity of an individual to COVID-19 infection might be affected by ACE2 polymorphism. To my knowledge, there are no clinical data to explain whether use of ARBs in COVID-19 patients with cardiovascular diseases is the same for all members or that some ARB members are preferred than others? This review tries to shed light on this issue. Materials and Methods: Wide literature search using many key words related to ARBs and COVID-19. Results: The newest ARBs (Olmesartan medoxomil and Azilsartan medoxomil) block the angiotensin II receptor 1 (AT1R) with inverse agonist activities, have no antagonistic effects on AT2R, upregulate ACE2 and stimulate ACE2/Ang-(1-7)/Mass receptor pathway. They are poor activators of peroxisome proliferator-activated receptor-gamma (PPAR gamma) whose activation is not needed for their metabolic benefits. In addition, Olmesartan medoxomil inhibits ACE and decreases the plasma level of angiotensin II. Conclusion: In spite of their favorable pharmacological profiles, there is no enough evidence to support choice of the newest ARBs rather than the old ones for treatment of cardiovascular morbidities in COVID-19 patients.