Angiotensin II - A Brief Review and Role in Severe SARS-COV-2 Sepsis

Gianmarco A. Carà, Laura Pasin, Ettore Alborino, Alexander Zarbock, Rinaldo Bellomo, Giovanni Landoni

Research output: Contribution to journalReview ArticleOtherpeer-review

4 Citations (Scopus)


The renin-angiotensin-aldosterone system (RAAS), whose major vasopressor effector is angiotensin II (ATII), has multiple activities and regulates sodium-water homeostasis and fluid and blood pressure homeostasis. RAAS plays a crucial role in cardiocirculatory shock because it counteracts hypotension and hypovolemia by activating different physiologic responses. Based on the encouraging results of the ATHOS-3 trial, the US Food and Drug Administration and the European Medicines Agency approved the use of ATII for catecholamine-resistant vasodilatory shock. More recently, ATII was used for the compassionate treatment of critically ill patients with COVID-19. Beyond its vasopressor properties, ATII was hypothesized to have antiviral activity because it induces internalization and degradation of angiotensin-converting enzyme 2 receptors used by SARS-Cov-2 to infect cells. Overall, the use of ATII in patients with COVID-19 showed promising results because its administration was associated with the achievement and maintenance of target mean arterial pressure, increased PaO2/FIO2 ratio, and decreased FIO2. The aim of this narrative review is to summarize the available knowledge on the use of ATII in patients with COVID-19.

Original languageEnglish
Pages (from-to)4496-4500
Number of pages5
JournalJournal of Cardiothoracic and Vascular Anesthesia
Issue number12
Publication statusPublished - Dec 2022


  • angiotensin-II
  • COVID-19
  • shock
  • vasopressor

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