Considerations on the rational use of beta receptor blockers in patients with Corona Virus Disease 2019 and cardiovascular disease

doi:10.3877/cma.j.issn.2095-655X.2020.03.012

Abstract

Abstract:

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters the host cell through spike protein (S protein) binding with angiotensin-converting enzyme 2 (ACE2) of type Ⅱ alveolar epithelial cells, consuming large amounts of ACE2, resulting in the imbalance of the renin-angiotensin system (RAS). Excessive angiotensin Ⅱ (Ang Ⅱ) acts on angiotensin receptor 1 (AT1R), promoting pulmonary inflammatory infiltration, pulmonary fibrosis, increasing pulmonary capillary permeability, and then causes pulmonary injury. Once the lung impaired, it would in return further deteriorate the cardiovascular conditions, and even deprive the life of cardiovascular patients. As one of the first-line prescribed medications for cardiovascular patients, β receptor blockers could lower the total mortality rate of cardiovascular patients by antagonizing the activation of sympathetic nervous system and deactivating the activity of RAS system, playing the critical role to slow down heart rate, reduce myocardial oxygen consumption, lower blood pressure and reduce malignant arrhythmias. However, β receptor blockers could selectively inhibit the β2 receptor on bronchial smooth muscle and induce or aggravate bronchospasm, which may further deteriorate pulmonary in cardiovascular patients with Corona Vinus Disease (COVID-19). Based on the mechanisms of β receptor blockers and their crucial roles in cardiopulmonary and vascular diseases, this paper illuminates the paradoxical scenarios of β receptor blockers application in patients with COVID-19 and cardiovascular disease during the epidemic.

Key words: 2019 novel coronavirus, Corona Virus Disease 2019, Cardiovascular disease, Beta receptor blockers, Rein-angiotensin system

Yuan Wang, Xuefei Bi, Zhiyun Wang, Shoudong Wei, Yongzhi Deng. Considerations on the rational use of beta receptor blockers in patients with Corona Virus Disease 2019 and cardiovascular disease[J]. Chinese Journal of Diagnostics(Electronic Edition), 2020, 08(03): 203-207.

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