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Unexpected-BP-Sensitivity-to-Angiotensin-II-in-a-P
Unexpected-BP-Sensitivity-to-Angiotensin-II-in-a-P
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Pdf Summary
This case study reports on an 88-year-old male patient with COVID-19, acute respiratory distress syndrome (ARDS), and septic shock who exhibited an unexpected sensitivity to low-dose Angiotensin II (Ang-2), allowing for rapid reduction in the need for high-dose vasopressors. The patient, with underlying conditions such as hypertension, coronary artery disease, and type 2 diabetes mellitus, was initially treated for COVID-19 with high-dose vasopressors due to worsening BP and respiratory status. After administration of Ang-2 at a low dose (10 ng/kg/min), the patient showed significant improvement and was weaned off vasopressors by ICU day 3. This rapid improvement, uncommon in most vasodilatory shock treatments, points to a potential unique interaction between SARS-CoV-2 infection and the body's Renin-Angiotensin System (RAS).<br /><br />The unexpected sensitivity to Ang-2 might suggest a COVID-19-induced dysregulation of ACE (angiotensin-converting enzyme) function or deficiency in endogenous Ang-2. Previous studies (like ATHOS-3) indicated that patients with lower endogenous Ang-2 levels respond more sensitively to treatments like Ang-2, though such sensitivity has also been observed in septic shock cases not related to COVID-19.<br /><br />Despite promising results, this report emphasizes the need for further studies to examine the role of Ang-2 in COVID-19, as biological interactions concerning Ang-2 and ACE2 (the main cellular entry receptor for SARS-CoV-2) remain unclear. The findings suggest a potentially significant role for Ang-2 treatment in COVID-19-related vasodilatory shock, warranting additional investigation and consideration for broader clinical use. Limited by its scope, the study does not rule out other potential contributing treatments like corticosteroids. Further research including measurement of Ang-2 levels and ACE2 activity in COVID-19 patients is recommended.
Keywords
COVID-19
acute respiratory distress syndrome
septic shock
Angiotensin II
vasopressors
Renin-Angiotensin System
ACE function
SARS-CoV-2
vasodilatory shock
clinical research
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