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| Credit CDC Hypertension |
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Shortly after the emergence of COVID-19 we learned that the causative virus - SARS-CoV-2 - bound to ACE2 receptor cells (see ACE2 Is the SARS-CoV-2 Receptor Required for Cell Entry), which immediately raised questions over the risks that millions of patients currently receiving ACE Inhibitor or ARB therapy for hypertension might face.
Early on, opinions were mixed - with a number of hypothesized downsides - including:
Patients who Take ACEIs and ARBs May Be at Increased Risk of Severe COVID-19
Mar 25, 2020 by
Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may increase the risk of severe COVID-19 cases, according to a hypothesis proposed by Professor James Diaz of Louisiana State University Health Sciences Center.
(Continue . . . )
At the same time, we saw this contrarian viewpoint:
ACEI/ARB Treatment May Benefit Patients With COVID-19 and Hypertension
Florence Chaverneff, Ph.D.
Treatment of patients with hypertension who are infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II type 1 receptor blockers (ARBs) may improve clinical outcomes, according to study results published in Emerging Microbes and Infections.(Continue . . . )
Despite this uncertainty, a number of leading journals cautioned against halting ACE or ARB therapy, citing insufficient evidence of harm (see AHA news release).
Three weeks ago, in WHO Scientific Brief: COVID-19 & The Use Of ACE Inhibitors or ARBs, the World Health Organization published a scientific brief that reviewed the (scant) existing literature - and while not exactly a ringing endorsement - found:
`. .. low-certainty evidence that patients on long-term therapy with ACE inhibitors or ARBs are not at higher risk of poor outcomes from COVID-19.'Although the evidence remains weak, early indications have been encouraging for those of us dependent upon these critical drugs.
While far from being the last word on the subject, today we have a meta-analysis published in the AHA journal Hypertension, which find decreased mortality ( among patients with hypertension) who are receiving ACEI or ARB therapy.
Decreased Mortality of COVID-19 with Renin-Angiotensin-Aldosterone System Inhibitors Therapy in Patients with Hypertension: A Meta-Analysis
Xiaoming Guo, Yueli Zhu, and Yuan HongOriginally published 27 May 2020https://doi.org/10.1161/HYPERTENSIONAHA.120.15572Hypertension. ;0
Abstract
The coronavirus disease 2019 (COVID-19) is caused by the infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), having gradually developed into a pandemic and endangered global health.
The continued use of angiotensin converting enzyme inhibitor (ACEIs) and angiotensin II receptor blockers (ARBs) which are part of renin-angiotensin-aldosterone system (RAAS) inhibitors in COVID-19 patients with hypertension has become controversial.
We conducted a meta-analysis by searching Pubmed, Web of Science, Scopus and Embase up to 13 May 2020. Data analyses were performed by the Cochrane Collaboration's Review Manager 5.3 software. Finally, we included 9 studies comprising 3936 patients with hypertension and COVID-19 infection.
Compared with non-ACEI/ARB treatment, ACEI/ARB treatment was not associated with disease severity (OR 0.71, 95 % CI 0.46-1.08, P 0.11, I2 59%) but was related to lower mortality of COVID-19 in patients with hypertension (OR 0.57, 95 % CI 0.38-0.84, P 0.004, I2 0).
In summary, ACEI/ARB therapy did not aggravate disease severity of COVID-19. Besides, ACEI/ARB therapy can decrease the mortality of COVID-19. Current evidence suggested that RAAS inhibitors should be continued in COVID-19 patients with hypertension. Future well-designed randomized controlled trials are needed to confirm these findings.PDF File
As always, I am not a doctor and none of this constitutes medical advice. Always consult your doctor before changing or stopping your medications.
