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Published on April 17, 2020

COVID-19 and ACE inhibitors: what’s the truth?

Heart Medicine

There is a lot of misinformation circulating regarding supposed cures and false or unproven warnings surrounding COVID-19.

Such is the case with the new paper exploring the possibility that the heart medications angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) increase the risk of severity of COVID-19. The paper, written by James Diaz, MD, professor and head of Environmental Sciences at LSU Health New Orleans School of Public Health, explains that the coronavirus binds to angiotensin converting enzyme 2 (ACE2) receptors to gain access into the lungs. The hypothesis is that since patients treated with ACEs and ARBs have increased numbers of ACE2 receptors in their lungs for the coronavirus to bind to, they may be at increased risk for more severe cases of respiratory illness.

Dr. Diaz believes his hypothesis is supported by a recent descriptive analysis of 1,099 patients known to have COVID-19 in China. The report noted more severe illness in patients with hypertension, heart disease, diabetes and chronic renal disease. All of those conditions are treated with ACE inhibitors and ARBs.

Since it is just a hypothesis and not a proven scientific fact, Cardiologist Peter Chiotellis, MD, FACC, at the Heart Center in Hyannis does not have any plans to change his patients’ medications.

“We do know that cardiac patients are at a higher risk, just in general, and a lot of cardiac patients are on either ACE inhibitors or ARBS, but there has been nothing shown in human studies or in the study of COVID-19 that this has put human patients at risk,” he said.

The American Heart Association, the American College of Cardiology, and the Heart Failure Society of America are saying that people should not stop taking these medications, Dr. Chiotellis said.

“In their joint statement they said that ‘there are no experimental or clinical data demonstrating beneficial or adverse outcomes among COVID-19 patients using ACE inhibitors or ARB medications. We urge urgent additional research that can guide us to optimal care.’ But they do say these recommendations will be updated to respond to the latest research,” he said.

A bigger fear than a possible link to COVID-19 severity is that people will hear this news and stop taking their medications, Dr. Chiotellis said. Patients should never stop taking any prescribed medication without talking to their doctor because the conditions that ACE inhibitors and ARBs treat are very serious conditions, like hypertension, cardiovascular disease, diabetes and chronic kidney disease. All of those and other pre-existing conditions automatically makes the coronavirus more serious.

“These drugs are actually proven to have a benefit so some patients would do a lot poorer coming off the medication,” he said. “We use these medications for high blood pressure but we also use them for heart failure patients. It’s been shown to improve ejection fraction and heart function of patients and, so, stopping them can lead to worsening hypertension and worsening heart disease. Everything is a risk/benefit. In this case, they are not saying that the risk is greater than the benefit.”