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Patients with severe COVID-19 infections commonly are older and have a history of hypertension. Almost 75% of patients who have died in the pandemic in Italy had hypertension. This raised multiple questions regarding a more severe course of COVID-19 in relation to hypertension itself as well as its treatment with renin\u2013angiotensin system (RAS) blockers, e.g. angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). We provide a critical review on the relationship of hypertension, RAS, and risk of lung injury. We demonstrate lack of sound evidence that hypertension per se is an independent risk factor for COVID-19. Interestingly, ACEIs and ARBs may be associated with lower incidence and\/or improved outcome in patients with lower respiratory tract infections. We also review in detail the molecular mechanisms linking the RAS to lung damage and the potential clinical impact of treatment with RAS blockers in patients with COVID-19 and a high cardiovascular and renal risk. This is related to the role of angiotensin-converting enzyme 2 (ACE2) for SARS-CoV-2 entry into cells, and expression of ACE2 in the lung, cardiovascular system, kidney, and other tissues. In summary, a critical review of available evidence does not support a deleterious effect of RAS blockers in COVID-19 infections. Therefore, there is currently no reason to discontinue RAS blockers in stable patients facing the COVID-19 pandemic.<\/jats:p>","DOI":"10.1093\/cvr\/cvaa097","type":"journal-article","created":{"date-parts":[[2020,4,6]],"date-time":"2020-04-06T19:11:08Z","timestamp":1586200268000},"page":"1688-1699","source":"Crossref","is-referenced-by-count":273,"title":["Hypertension, the renin\u2013angiotensin system, and the risk of lower respiratory tract infections and lung injury: implications for COVID-19"],"prefix":"10.1093","volume":"116","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4818-211X","authenticated-orcid":false,"given":"Reinhold","family":"Kreutz","sequence":"first","affiliation":[{"name":"Charit\u00e9-Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, Institut f\u00fcr Klinische Pharmakologie und Toxikologie, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Engi Abd El-Hady","family":"Algharably","sequence":"additional","affiliation":[{"name":"Charit\u00e9-Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, Institut f\u00fcr Klinische Pharmakologie und Toxikologie, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Azizi","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris-Descartes; AP-HP, H\u00f4pital Europ\u00e9en Georges-Pompidou, Hypertension Department and DMU CARTE; INSERM, CIC1418, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8919-1661","authenticated-orcid":false,"given":"Piotr","family":"Dobrowolski","sequence":"additional","affiliation":[{"name":"Department of Hypertension, National Institute of Cardiology, Warsaw, 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