Concerns about blood pressure medications and COVID-19
ACE inhibitors AND ARB’s
COVID-19 binds to the receptor of angiotensin-converting enzyme 2 (ACE2) which is found in various cells throughout the body including the lungs. This is an entry point for the virus and helps the virus gain access to the lungs. Renin-angiotensin-aldosterone system inhibitors may increase ACE2 levels.
A recent correspondence was published in Lancet by Lei Fang and others about angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) and COVID-19. The correspondence was based on 3 studies, one that involved 1099 patients with confirmed COVID-19 in China, and it was concluded that patients on ACE inhibitors or ARBs are at increased risk for adverse outcomes. They further suggested an alternative to using ACE inhibitors or ARBs could be calcium channel blockers.
As of now there is no recommendation to stop using these agents. Per the correspondence suggestion it is crucial to know that not all patients can be switched to calcium channel blockers (CCBs). This includes diabetes patients utilizing ACE inhibitors for kidney protection and congestive heart failure patients who may already be on a CCB and ACE inhibitor. If patients stop taking their ACE inhibitor or ARB it may actually worsen cardiovascular or kidney disease and lead to increased mortality.
It is urged that larger clinical trials need to be performed prior to altering life-saving medications within this population. Patients with underlying conditions such as cardiovascular or diabetes need to take precautions and quarantine to avoid others that are infected with COVID-19. Dr. Diaz, a professor at LSU Health New Orleans School of Public Health stated in an article in Science Daily, “Patients treated with ACEIs and ARBs for cardiovascular diseases should not stop taking their medicine, but should avoid crowds, mass events, ocean cruises, prolonged air travel, and all persons with respiratory illnesses during the current COVID-19 outbreak in order to reduce their risks of infection."
To note, there are two clinical trials set to be launched by the University of Minnesota that will study if losartan can prevent multi-organ failure in hospitalized patients with COVID-19 pneumonia and the second will evaluate if losartan can prevent COVID-19 hospitalizations. The thought is losartan is an angiotensin receptor blocker and this may block the entry-point for the COVID-19 virus. For more details about these clinical trials please log on to clinicaltrials.gov.
If you have concerns and are taking an ACE inhibitor or ARB speak to your doctor.
References:
1. https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19?source=history_widget#H2110619195. Accessed on March 28, 2020
2. Receptor Recognition by the Novel Coronavirus from Wuhan: an Analysis Based on Decade-Long Structural Studies of SARS Coronavirus. Yushun Wan, Jian Shang, Rachel Graham, Ralph S. Baric, Fang Li. Journal of Virology Mar 2020, 94 (7) e00127-20; DOI: 10.1128/JVI.00127-20. Accessed on March 28, 2020
3. Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med 6 2020; https://doi. org/10.1016/S2213-2600(20)30116-8. Accessed on March 28, 2020
4. ACE inhibitors and angiotensin receptor blockers may increase the risk of severe COVID-19, paper suggests. https://www.sciencedaily.com/releases/2020/03/200323101354.htm. A possible explanation for the severe lung complications being seen in some people diagnosed with COVID-19 is proposed in a new article. Accessed on March 28, 2020
