Interactions between the renin–angiotensin–aldosterone system and COVID-19

Since 2019, a substantial body of evidence has partially linked the SARS-CoV-2 infection severity and poor prognosis to renin–angiotensin–aldosterone system (RAAS) activation. There are two aspects to the RAAS involvement with COVID-19 development. First, SARS-CoV-2 entry into the host cell is mainly mediated through ACE2 receptor, and second, SARS-CoV-2 infection is associated with increased angiotensin II levels. The leveraging of the detrimental ACE/ANG II/AT1R arm over the protective ACE2/ANG (1–7)/MAS of the RAAS system following COVID-19 emphasizes the importance of RAAS targeting drugs in modulating the poor cardiovascular prognosis of the disease. This chapter summarizes the most up-to-date conclusions around major drugs targeting the RAAS along with their potential role in COVID-19 treatment.