Updated: Apr 29
1 APR 2020
Recently, a lot of patients have expressed concerns about taking their ACE-Is (Angiotensin Converting Enzyme Inhibitors) or ARBs (Angiotensin Receptor Blockers) for their hypertension, kidney or heart conditions, following news that meds in these categories may confer harm for those contracting COVID-19 infection.
I wish to share the following information:
In response to a paper(1) suggesting theoretical harm of ACE-Is and ARBs for COVID-19 infections, a joint statement(2) by AHA, ACC and HFSA, as well as statements by ESC, ESH, CCS and ISH have all uniformly urged patients on these medications to continue taking them. The response is based on the absence of evidence that these medications cause harm in COVID-19 infected patients. The literature, au contraire, is replete with clinical studies showing that use of ACE-Is/ARBs was associated with reducing the risk of pneumonia and respiratory complications(3,4).
University of Minnesota on 16 March commenced a multi-center, double-blinded clinical trial(5) (clinicaltrials.gov, identifier: NCT04312009) of COVID-19 infected patients requiring inpatient hospital admission randomized to daily treatment with Losartan (an ARB) or placebo.
Based on the prevailing evidence in the scientific literature and the published Guidelines by most of the International Cardiovascular Scientific Bodies, I recommend our patients continue, and not stop taking their ARBs or ACE-Is medications. This recommendation will be adjusted as needed, to correspond with the latest research and published Guidelines.
Fang L et al. Lancet Respir Med. 2020.
Lai CC et al. Int J Chron Obstruct Pulmon Dis. 2018;13:867–874. https://doi:10.2147/COPD.S158634
Kim J et al. Int J Chron Obstruct Pulmon Dis. 2016;11:2159–2166. https://doi:10.2147/COPD.S104097