COVID-19 and the Use of Antihypertensive Drugs Known As the ACE2 Angiotensin-Converting Enzyme 2 and Angiotensin Receptor Blockers Known As Arbs
This has become a highly contentious topic during this COVID-19 pandemic. Initially there existed no evidence and concern existed amongst those patients taking the common antihypertensive treatments with ACE-2 inhibitors and angiotensin receptor blockers (ARBS). These drugs are used widely for hypertension, heart disease, chronic kidney disease and are prescribed globally. There was no evidence.
The concern was that the SARS-CoV-2 virus infected cells via specific binding sites to angiotensin-converting enzyme 2, which is expressed in the lung and other tissues. This led to worry and speculation that the use of the common ARB or ACE-2 inhibitors could lead to an increased expression of ACE-2 in the respiratory tract, therefore increasing the risk of both becoming infected and those patients taking them developing severe life-threatening complications from COVID-19.
This hypophysis gained attraction via social media and also in the medical press. These patients began to withdraw and substitute these treatments, prompting international cardiovascular and hypertension specialists’ societies to issue statements of reassurance while acknowledging that there was no high quality data to refute this.
Fortunately, as described by Bryan Williams in The Lancet dated May 14, 2020, this now been studied and data is presented from Francisco De Abajo and colleagues from a case population study of 1139 adult patients admitted to hospital in Madrid with COVID-19 during March 2020. These patients were carefully matched with population controls. The main outcome measure was admission to hospital with a swab confirmed COVID-19. They found there was no associated increased risk of COVID-19 requiring admission to hospital in those patients taking ARBs and ACE-2 inhibitors compared with patients taking other antihypertensive drugs. This finding was also consistent with most other recent observational studies.
However, there was one study using observational data from 169 hospitals in Asia, Europe and North America that reported a possible enhanced benefit of ACE inhibitors compared with angiotensin receptor blockers on mortality, but the authors cautioned against this interpretation because of any potential unmeasured confounding variable.
Diabetes is associated with poorer outcomes in patients with COVID-19. These patients have traditionally been prescribed ARBs or ACE2 inhibitors either to protect their renal function or for hypertension. Interestingly, this study showed that the use of these medications compared with other antihypertensive drugs almost halved the risk of adverse outcomes in those patients with COVID-19 who had diabetes. Other studies had suggested that the use of ARBs and ACE2 might confer protection against complications and deaths in patients with COVID-19 versus those taking other antihypertensive drugs. These other studies, however, were not restricted to patients with diabetes.
Emerging data appears to show the excess risk of admission to hospital and intensive care units for patients with any kind of antihypertensive medication versus non-users. There also appears to be more fatal outcomes. The potential association of antihypertensive treatment and increased risk of severe COVID-19 is concerning but it probably reflects that the use of these drugs is in older patients who invariably have multiple comorbidities. Taking into account and trying to adjust for all comorbidities and looking at other studies, there is no evidence to support that the use of ARBs or ACE2 inhibitors increases the risk of severe COVID-19 disease. Findings from some of the studies even suggest that treatment with these medications might reduce the risk of severe complications or death due to
COVID-19.
The London General Practice has kept abreast with all developments during this dreadful COVID-19 pandemic. The practice has adapted to this challenging time and now provides 24-hour video or telephone consultations and is very happy to have face-to-face consultations or home visits for those with no acute COVID symptoms with the doctors wearing full PPE.
The practice is concerned about those patients with chronic conditions such as cardiovascular disease and those with undiagnosed cancer and is recommending that all patients with any concern should seek advice from their health professional or telephone The London General Practice is open and any medical issue can be reviewed and alleviated.
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