Fast-track publication and care management: exploring the evidence for the use of RAS Inhibitors in patients with hypertension and COVID-19

Abstract

Over 467 million people were infected and more than 6.0 million died from COVID-19 between 2020 and March, 17, 2022. Scientific knowledge of both the virus etiopathogenesis and preventive measures and therapeutics for the disease evolved rapidly. New knowledge production and dissemination mechanisms were applied to hypothesis testing, including fast track assessment of papers and open access bases, engendering the popularization of science. Such scenario favors the transmission of information lacking scientific foundation, causing a feeling of social insecurity.  This paper, written in a narrative revision form, investigates a specific process of hypothesis generation and testing. It analyzes evolution of the knowledge of the relevance of the renin-angiotensin-aldosterone system (RAAS), more specifically of the angiotensin converting enzyme 2 (ACE2), as well as of the drugs that interfere with the RAAS, the angiotensin converting enzyme inhibitors (ACEI) and the angiotensin receptor blockers (ARB) in the clinical outcome of patients with both COVID-19 and hypertension. The relevance of the cardiovascular system, RAAS in particular, in COVID-19, was soon acknowledged.  Hypertension is a risk factor for disease severity and death and ACE2 is the entry gate for virus invasion of the cell. These initial findings led to recommendation for suspension of RAAS-acting drugs, a position that was questioned by specialists and reviewed after consistent studies were conducted.  In the face of a new and challenging clinical condition, the relevance of critical analysis of the literature and clear communication of the findings is reassured, a role to be played by a prompt and scientifically-based regulatory system, in close partnership with specialists’ societies