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Coronavirus Quandaries for Patients with Cardiovascular Disease


Janine Bartholomew
Department of Biology
Carlow University


This directed case study tells the story of “Arie,” an anatomy and physiology student who has recently switched to distance learning due to the COVID-19 pandemic. Now home, her mother asks her opinion about the recent news articles about high blood pressure medication making COVID-19 infections worse. She is worried about Arie’s elderly grandfather, who takes medication to treat his hypertension and heart failure. Arie uses her physiology background to explain blood pressure regulation and the mechanism of drug actions to her mom. Arie learns about the novel components of the renin-angiotensin-aldosterone-system (RAAS) pathway, Ang1-7 and ACE2, and their relationship to COVID-19 in a conversation with her professor. They also discuss the strength of evidence from the scientific publications hypothesizing anti-hypertensive medications may worsen infection, and hear an opinion from her grandfather’s cardiologist. The case also explores drug interventions for hypertension, and ends with a discussion of scientific investigations and their strength of evidence for supporting hypotheses. The case is relevant to courses studying blood pressure physiology or treatment, such as anatomy and physiology, pharmacology, and pathophysiology courses in science, nursing, pre-med, health science, or pharmacy programs.


  • Identify the components of the classical renin-angiotensin-aldosterone system (RAAS) and how they work to regulate blood pressure.
  • Describe the novel components of the RAAS system that aim to negatively regulate angiotensin II and understand how SARS-CoV-2 exploits ACE2 for cell entry.
  • Identify current pharmacotherapies that decrease blood pressure and hypothesize others based on classical and novel RAAS components.
  • Compare and contrast the types of scientific studies and their significance based on the strength of the evidence they generate.


Hypertension; RAAS; renin; angiotensin; aldosterone; cardiovascular disease; ACE inhibitors; COVID-19; SARS-CoV-2; coronavirus; ACE2; blood pressure regulation; evidence

Topical Areas

Science and the media

Educational Level



PDF, PowerPoint

Type / Methods

Directed, Discussion



Subject Headings

Biology (General)  |   Physiology  |   Medicine (General)  |   Nursing  |   Pharmacy / Pharmacology  |   Public Health  |   Science (General)  |  

Date Posted


Teaching Notes



Supplemental Materials

The optional PowerPoint presentation below includes figures from the case that the instructor may choose to project in class.

  covid19_raas.pptx (~1.2 MB)

Answer Key
