Tens of millions of people take blood pressure medications called ACE inhibitors (ACEIs) or ARBs, angiotensin receptor blockers. ACEIs are drugs such as lisinopril, benazepril, captopril, enalapril and fosinopril. If you see a “pril” in the name, the drug is probably an ACE (angiotensin converting enzyme) inhibitor. ARBs include drugs like losartan, olmesartan, telmisartan and valsartan. ARBs have “sartan” in the name. Do you need to worry about COVID-19 if you are taking one of these drugs?
Why Worry About COVID-19?
Because the SARS-CoV-2 virus uses the ACE-2 receptor to enter cells, some scientists have asked whether ACE inhibitors or ARBS might affect the course of the infection. They have expressed concern that the coronavirus might gain entry into cells more easily if such drugs were on board.
That’s possibly because the body might increase the number of ACE-2 receptors it makes if someone were taking an ACE inhibitor. The body is always trying to achieve homeostasis. If receptor sites are affected by a medication, the body might try to compensate by making more.
No Need to Worry About COVID-19 and ACEIs or ARBs:
An answer to this question has come from a study published in JAMA Cardiology (April 23, 2020). Researchers in Wuhan, China, looked at records of patients hospitalized with COVID-19. Those who were taking ARBs or ACE inhibitors had no difference in the disease progression and risk of death during hospitalization.
The authors conclude:
“The current findings did not identify an association between treatment with ACEIs/ARBs and either severity or clinical outcomes of COVID-19 hospitalizations in patients with hypertension. These data support current guidelines and societal recommendations for treating hypertension during the COVID-19 pandemic.”
People’s Pharmacy Perspective:
This is not the last word on ACE inhibitors and ARBs. An article in the New England Journal of Medicine (April 23, 2020) offers an in-depth analysis of the pros and cons of ARBs and ACEIs during the coronavirus pandemic. We encourage health professionals to review this thoughtful analysis.
The authors encourage their colleagues to continue prescribing ACE inhibitors and ARBs to patients
“…in otherwise stable condition who are at risk for, are being evaluated for, or have Covid-19, a position now supported by multiple specialty societies.”
Given these words of encouragement by people way smarter than us, we would not worry about COVID-19 any more than normal if you are taking one of these drugs for hypertension.
Less Reason for People on ARBs or ACE Inhibitors to Worry About COVID-19:
When scientists first learned that SARS-CoV-2 uses the ACE2 receptor to get into human cells and infect them, people began to worry about COVID-19 being more dangerous for people on medications working through these receptors. A recent meta-analysis of ten studies should reassure them (Evidence-Based Medicine, Clinical Trials and Their Interpretations, Aug. 24, 2020). There were nearly 29,000 people included in these trials.
The investigators found that people taking ACE inhibitors or ARBs for hypertension were two-thirds less likely to die or require intensive care ventilation. Approximately one third of the hypertensive COVID-19 patients in the study were taking one of these medicines.
The authors do not recommend that people start taking one of these drugs against COVID-19. Instead, they emphasize that people already taking such medicine for high blood pressure should not stop. These patients may be getting unexpected protection against the coronavirus.
Needless to say, even people taking an ARB or an ACE inhibitor can become very ill or even die as a result of COVID-19 infection. Staying out of crowded areas, avoiding sick people, wearing face masks and washing hands are still very important preventive measures.
Learn More:
To learn more these medications and nondrug ways to help control hypertension you may wish to read our eGuide to Blood Pressure Solutions. It was recently revised to keep you up-to-date! You will find this electronic resource in the Health eGuide section of our website.
