Coronavirus and blood pressure medication
In the past few months, there have been repeated speculations that taking blood pressure medication could make you more susceptible to infection with the novel coronavirus SARS-CoV-2 and also promote severe COVID-19 disease courses. Now there is new knowledge.
Many patients are unsettled by speculation: Blood pressure lowerers could make them more susceptible to coronavirus infections or lead to more severe COVID-19 diseases. But like the German Hypertension League now in a current one Message reported, such concerns are unjustified.
Continue to take antihypertensive drugs
The coronavirus SARS-CoV-2 uses the enzyme ACE2 to enter the cells. This disease-causing mechanism of SARS-CoV-2 has unsettled many patients with high blood pressure, because the antihypertensive therapy (with ACE inhibitors / ACEi or angiotensin receptor blockers / ARB) can lead to a slight increase in ACE2 – and more ” Portals of entry ”, so the fear, could make those affected more susceptible to infection with the new pathogen.
The European Society of Hypertension (ESH) classified this risk in one opinion however, as very low and advised high blood pressure patients to continue to take their antihypertensive medication as prescribed.
Protection, harm or no impact?
However, the data on the administration of ACEi and ARB in seriously ill COVID-19 patients has so far been quite contradicting. Some studies have questioned the safety of antihypertensive drugs in COVID-19 sufferers, while others have provided evidence that they could even protect those affected from serious disease.
According to the Hypertension League, ACE2 also has a protective effect on lung function: it splits harmful angiotensin II, without this conversion of angiotensin II into “harmless” angiotensin 1-7, lung damage can occur; a decrease in ACE2 even led to more severe disease courses in the animal model of acute lung failure. This was shown by a basic study that was published at the end of July in the renowned specialist journal “Science“Was published.
However, this publication also emphasizes that this protective function could be overridden by the virus itself: As with many guest cell-virus interactions, the expression of the virus receptor, i.e. ACE2, in SARS-CoV-2-infected cells is triggered by the pathogen downregulated.
In summary, it has so far been unclear what role the antihypertensive agents actually play in the disease process, whether they protect patients with severe COVID-19 courses or whether they have no influence at all on the infectious disease.
Less critical gradients
At the end of August, the journal “Current Atherosclerosis Reports“An observational study from the UK that analyzed data from more than 28,000 patients admitted to hospital for COVID-19. The result showed that the rate of deaths and critical courses among those affected who took antihypertensive drugs was reduced by almost 34 percent (OR: 0.66).
“That was an important and clear signal for us, but ultimately observational studies have no conclusive evidence for a causal relationship. The positive effect could also have resulted from other factors, for example simply from the fact that patients with untreated blood pressure have a higher risk of death. So the study does not prove that blood pressure medication protects against severe COVID-19 diseases, ”explains Prof. Dr. med. Ulrich Wenzel, University Medical Center Hamburg-Eppendorf, CEO of DHL®.
New results presented
A few days ago, the results of the BRACE-CORONA study, the first randomized study on COVID-19 and ACEi / ARB, were presented at the virtual congress of the “European Society of Cardiology” (ESC).
Like the ESC in a Message writes, 659 hospitalized COVID-19 patients were included in the study and randomized into two groups: In one group, the medication with ACEi / ARB was continued, in the second it was discontinued. After 30 days it was analyzed whether there was a difference in survival and in the length of the hospital stay.
The result showed that this was not the case and that the results were comparable in both groups. “Because these data indicate that discontinuing routine use of these drugs is of no clinical benefit in hospitalized patients with mild to moderate COVID-19, they should generally be continued for patients with an indication,” said lead researcher Professor Renato Lopes from Duke Clinical Research Institute, Durham, USA.
Possible uncertainties lifted
“We think this study will remove any uncertainty that may have persisted. We can now say with a fairly high degree of certainty that the blood pressure medication is in no way harmful and worsens a COVID-19 disease or even increases the risk of death, “said DHL CEO Wenzel.
“Patients can now take their antihypertensive drugs as prescribed with peace of mind and, given the SARS-CoV-2 pandemic, do not have to worry about exposing themselves to a higher risk. We are glad that this randomized study has finally brought clarity, ”says the doctor. (ad)
Author and source information
This text complies with the requirements of specialist medical literature, medical guidelines and current studies and has been checked by medical professionals.
- German Hypertension League: BRACE-CORONA study shows: ACE inhibitor therapy can also be continued in hospitalized COVID-19 patients (accessed: 07.09.2020), German Hypertension League
- European Society of Hypertension: Statement of the European Society of Hypertension (ESH) on hypertension, Renin-Angiotensin System (RAS) blockers and COVID-19, (veröffentlicht: 15.04.2020), European Society of Hypertension
- Nicholas J. Matheson, Paul J. Lehner: How does SARS-CoV-2 cause COVID-19?; in: Science, (veröffentlicht: 31.07.2020), Science
- Baral R, White M, Vassiliou VS et al.: Effect of Renin-Angiotensin-Aldosterone System Inhibitors in Patients with COVID-19: a Systematic Review and Meta-analysis of 28,872 Patients; in: Current Atherosclerosis Reports, (veröffentlicht: 24.08.2020), Current Atherosclerosis Reports
- European Society of Cardiology: First randomised trial backs safety of common heart drugs in COVID-19 patients, (Abruf: 07.09.2020), European Society of Cardiology
This article is for general guidance only and should not be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor.