In a nutshell
This study investigated if blood pressure drugs that target the angiotensin-converting enzyme (ACE) affect COVID-19 outcomes.
They found that ACE drugs were not associated with worse outcomes in COVID-19.
Some background
Hypertension or high blood pressure (BP) is a common condition. Anti-hypertensive (AHT) drugs are one of the most effective ways to manage BP. One target for AHTs is angiotensin-converting enzyme 2 (ACE2). Two types of AHTs target ACE2. These are angiotensin receptor blockers (ARBs) and ACE inhibitors (ACEi). These drugs block ACE2 activity. However they also increase the expression of ACE2 receptors.
COVID-19 is a respiratory disease. It is caused by infection with the SARS-CoV2 virus. The SARS-CoV2 enters cells using the ACE2 receptor. The effect of ARBs/ACEis in COVID-19 has been questioned. Laboratory experiments suggest ARBs/ACEis might protect in COVID-19. Increased ACE2 receptor expression due to ARB/ACEi use could increase the risk of COVID-19. It is unclear if there is an association between ARB/ACEi use and COVID-19 outcomes.
Methods & findings
This study included 251 COVID-19 patients. 126 patients had pre-existing hypertension. 125 patients without hypertension were used as a control group. Patients with hypertension were grouped as ARB/ACEi or non-ARB/ACEi. The primary outcomes were the number of critical patients and the mortality rate.
BP levels were similar in the ARB/ACEi and non-ARB/ACEi groups. The ARB/ACEI group had lower levels of c-reactive protein (CRP). This suggests lower levels of inflammation. ARB/ACEi patients had lower levels of procalcitonin. This indicates a lower risk of infection.
The proportion of critical patients was 9.3% in the ARB/ACEi group. This compared to 22.9% of non-ARB/ACEi patients. The mortality rate was 4.7% in ARB/ACEi patients. This compared to 13.3% of non-ARB/ACEI patients. However, these differences were not statistically significant.
The bottom line
The authors concluded that ACE drugs were not associated with worse outcomes in COVID-19. The authors suggest patients keep using their prescribed medication during this period.
The fine print
The number of patients in this study was low. Larger studies are needed.
What’s next?
If you have any concerns regarding hypertension management please discuss this with your physician.
Published By :
Hypertension (Dallas, Tex. : 1979)
Date :
Apr 29, 2020
