In the newspaper MEUSE of March 25, 2020, it was mentioned that certain drugs to fight “blood pressure problems” would increase the risk of contracting COVID-19.
As a cardiologist, I would like to add some nuances to this subject. The article focuses primarily on ACE inhibitors and ARBs that are very effective in reducing the mortality associated with certain chronic cardiovascular pathologies such as high blood pressure, heart failure, coronary artery disease and diabetic nephropathy. CAUTION: The dangers of stopping these drugs unjustifiably are enormous.
In order for the coronavirus to enter and infect a cell, it must recognize a receptor (ACE2) present in it. The increased expression of ACE2, especially in cardiovascular diseases (heart failure, high blood pressure, diabetes), could be associated with an increased risk of contracting COVID-19 and more severe symptoms. Many cardiovascular drugs are capable of modulating the tissue expression of ACE2. BUT, contrary to the messages conveyed, several studies suggest that high levels of ACE2 could limit the lung damage induced by viral infection. For example, administration of ARA-II (losartan) may improve the respiratory function of infected mice. Two clinical studies are currently underway to test the beneficial effects of losartan in patients infected with COVID-19 and a pilot study is evaluating the administration of a recombinant form of ACE2.
In practice, in the absence of clinical evidence and clear experimental data, it is not recommended to stop chronic treatment with ACE inhibitors or ARAII as part of a possible “preventive” effect on COVID-19 infection, especially since a blood pressure or heart failure worsening could be harmful. In addition, changes in antihypertensive drugs would require patients to go to the pharmacy and possibly have blood tests, which would increase the risk of exposure to COVID-19. Changes in classes of antihypertensive drugs also require frequent dose adjustment and management of possible side effects. On the other hand, the current recommendations of scientific societies recommend, apart from critical situations, to continue treatment with ACE inhibitors or ARAII in case of infection with COVID-19. Also, these recommendations could be brought to evolve quickly, in view of the results of the clinical trials in progress.
Patrizio Lancellotti