Tag: ACE Inhibitors

When it comes to COVID-19, the role blood pressure medications like angiotensin-converting enzyme (ACE) inhibitors (e.g. Lotensin, Vasotec, and Zestril) and angiotensin-receptor blockers or ARBs (e.g. Losartan/Cozaar and Irbesartan/Avapro) has spanned a full spectrum of possibly having a beneficial effect to potentially worsening outcomes. The reason these medications have come under scrutiny lies with the way SARS-CoV-2 attaches to and then invades human cells. The virus attaches to a receptor called ACE2, present on lung, heart, kidney, gut and nasal cells, and with that attachment begins the process of invading the cell. This same ACE2 receptor plays a role in the mechanism of action for both medications.

Early reports from China indicated that a significant number of the very sick also suffered from hypertension. As SARS-CoV-2’s mechanism of viral attachment to cells became more clear, it led Lei Fang from the University of Basel in Switzerland along with other colleagues to postulate a possible up-regulation of ACE2 receptors for people taking this class of anti-hypertensives might facilitate viral attachment and lead to higher infection rates and/or more severe disease. From that, the question of whether to discontinue these medications for people who are infected with SARS-CoV-2 to help prevent severe disease or even discontinue these medications in healthy individuals has been posited.

On May 1 the NEJM published the results of three observational studies of 8,910 (11 centers around the world), 6,272 (Lombardy, Italy) and 5,894 (New York) patients found no link between ACE inhibitors or ARBs in risk of death, likelihood of infection or seriousness of infection. These observational studies should be followed up by larger randomized studies but they provide a solid starting point for answering the question of whether these medications should be discontinued–they shouldn’t. This early data suggests you should keep taking your ACE Inhibitors and ARBs and that doctors should continue them in the hospital should you become sick.

To highlight how much we don’t know about SARS-CoV-2, it is also postulated that these medications, particularly the ARBs, may have a protective role against severe disease. The ARBs, as the name suggests, block the ACE2 receptor and may prevent viral adherence to it. Studies are underway to answer this question but data is not available at this time.