Covid-19 Diary -- March 18, 2020 -- Blood Pressure Medicine & Covid-19

Covid-19 Diary -- March 18, 2020 -- Blood Pressure Medicine  & Covid-19

I was talking to a friend today when she mentioned two close friends of hers are on blood pressure medication.

Because I, unfortunately, have been attuned to the Novel Coronavirus outbreak for some time I had logged away in my brain something about the possibility —note, the possibility— of those who take certain types of blood pressure medicine may be more at risk from serious complications from the virus.

This is from the medical journal, The Lancet, published online March 11, 2020:

The most distinctive comorbidities of 32 non-survivors from a group of 52 intensive care unit patients with novel coronavirus disease 2019 (COVID-19) in the study by Xiaobo Yang and colleagues1 were cerebrovascular diseases (22%) and diabetes (22%). Another study2 included 1099 patients with confirmed COVID-19, of whom 173 had severe disease with comorbidities of hypertension (23·7%), diabetes mellitus (16·2%), coronary heart diseases (5·8%), and cerebrovascular disease (2·3%). In a third study,3 of 140 patients who were admitted to hospital with COVID-19, 30% had hypertension and 12% had diabetes. Notably, the most frequent comorbidities reported in these three studies of patients with COVID-19 are often treated with angiotensinconverting enzyme (ACE) inhibitors; however, treatment was not assessed in either study.

 

And, from the same publication:

Human pathogenic coronaviruses (severe acute respiratory syndrome coronavirus [SARS-CoV] and SARSCoV-2) bind to their target cells through angiotensin-converting enzyme 2 (ACE2), which is expressed by epithelial cells of the lung, intestine, kidney, and blood vessels.4 The expression of ACE2 is substantially increased in patients with type 1 or type 2 diabetes, who are treated with ACE inhibitors and angiotensin II type-I receptor blockers (ARBs).4 Hypertension is also treated with ACE inhibitors and ARBs, which results in an upregulation of ACE2.5 ACE2 can also be increased by thiazolidinediones and ibuprofen. These data suggest that ACE2 expression is increased in diabetes and treatment with ACE inhibitors and ARBs increases ACE2 expression. Consequently, the increased expression of ACE2 would facilitate infection with COVID-19. We therefore hypothesise that diabetes and hypertension treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19. I

 

The American College of Cardiology released the following March 17, 2020:

The ACC concludes:

Currently there are no experimental or clinical data demonstrating beneficial or adverse outcomes with background use of ACE inhibitors, ARBs or other RAAS antagonists in COVID-19 or among COVID-19 patients with a history of cardiovascular disease treated with such agents. The HFSA, ACC, and AHA recommend continuation of RAAS antagonists for those patients who are currently prescribed such agents for indications for which these agents are known to be beneficial, such as heart failure, hypertension, or ischemic heart disease. In the event patients with cardiovascular disease are diagnosed with COVID-19, individualized treatment decisions should be made according to each patient’s hemodynamic status and clinical presentation. Therefore, be advised not to add or remove any RAAS-related treatments, beyond actions based on standard clinical practice.

 

Please contact your doctor if you are taking ACE inhibitors or ARBS for blood pressure or diabetes or heart disease.  Reference the above, linked  Lancet article.   Some people on ACE and ARBS have contacted their doctors and made changes in their medications.

Others, like my friend’s friends, concluded that their doctors will let them know if there are increased dangers.

Doctors are busy on any given day.  On the days heading into a tsunami of sickness, they may want to call but can’t.

News GP has a good article explaining the interaction of ACE inhibitors and ARBs

This video interview with Dr. Anthony Fauci from today, March 18, 2020, has a segment on blood pressure medications and Covid-19 at 10:30 into the interview.

Science-based channels focusing on Covid-19:

Dr. John Campbell

MedCram

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