By now, I am sure most of you have heard something about ACEi’s (angiotensin converting enzyme inhibitor) and ARB’s (angiotensin II receptor blockers) with their link to COVID-19. Both of these classes of medications are very widely used all over the world to treat hypertension (high blood pressure), cardiovascular disease, and slow the progression of kidney disease. They are very well tolerated by most people and often have great results with lowering blood pressure. Common drug names are below:
lisinopril (Prinivil, Zestril)
Angiotensin II Receptor Blockers
While we do not yet know for sure the impact of these drugs in relation to COVID-19, we do know that anybody with a history of hypertension, cardiovascular disease, and diabetes/metabolic syndrome are at a greater risk of having a severe case of COVID-19, potentially requiring extensive ICU care. It also appears, based on the newest data from Wuhan, that having these comorbidities has a 2-3 fold increase in mortality rate from COVID-19. Current case fatality rates for comorbid conditions are: hypertension at a 6.0%, cardiovascular disease at 10.5%, cancer at a 5.6%, chronic respiratory disease at a 6.3%, and diabetes at 7.3%.
So what do these drugs have to do with COVID-19? It turns out human angiotensin-converting enzyme 2 (ACE2) is a functional receptor for the coronavirus to enter our body; it is the “doorway” so to speak. We discovered this from the original SARS-CoV outbreak in 2002-2003. We have ACE2 receptors on many cells in our body; including the lungs, heart, blood vessels, and intestines. Both, ACEi’s and ARB’s, increase the ACE2 receptors, therefore we would assume these drugs can also increase the incidence of the virus to gain access…however the opposite seems to be true. Based on a recent study out of China, their preliminary results show that women and children have more ACE2 receptors than men and older people. Yet, we know women and children are less likely to get COVID-19, and less likely to have a severe illness. So now the research is focusing on why an increase in these ACE2 receptors actually decreases your risk of viral entry and may cause slight protection. If you want an in-depth biochemical explanation of this process, watch this video for a great breakdown.
The original thought was that stopping the ACEi or ARB would decrease infection rates by decreasing the ACE2 receptors. There was also some thought that adding an ARB to an infected individual, may have downstream protective mechanisms to help prevent the severe lung injury seen in COVID-19. But, as of right now, we do not have sufficient evidence for either stopping or starting these drugs. However, we do have a lot of evidence on the benefits of these medications in treating hypertension, cardiovascular disease, and slowing the progression of chronic kidney disease. Despite all of the confusion, the bottom line: DO NOT stop either your ACEi or ARB medications without talking to your provider. The current recommendation from the American Academy of Cardiology is to properly control your blood pressure by staying on your medications. If you are on an ACEi or ARB medication and feel overly anxious about what to do, please do not hesitate to reach out to our office and make an appointment with your provider to discuss alternative medications for blood pressure control.