Concerns about blood pressure medications and COVID-19
COVID-19 binds to the receptor of angiotensin-converting enzyme 2 (ACE2). This receptor is found in various cells throughout the body including the lungs. It is an entry point for the virus and helps the virus gain access to the lungs. This particular receptor also plays a role in blood pressure in which many common blood pressure medications target.
A recent correspondence was published in Lancet by Lei Fang and others about COVID-19 and two classes of blood pressure medications, ACEIs (angiotensin-converting enzyme inhibitors) and ARBs (angiotensin receptor blockers). Based on the observation patients taking ACEIs and ARBs who have COVID-19 were at increased risk for adverse outcomes. The correspondence was based on 3 studies, with one of the studies involving 1099 patients with confirmed COVID-19 in China. The authors further suggested that patients should be switched from ACEI or ARB to a calcium channel blocker (CCB).
As of now there is no recommendation to stop using these agents. It is crucial to understand that not all patients can be switched to CCBs. This includes diabetes patients utilizing ACEI for kidney protection and congestive heart failure patients who may already be on a CCB and ACEI. 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:
- https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19?source=history_widget#H2110619195. Accessed on March 28, 2020
- 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
- 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
- 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
