Hypothesis Questions Whether ACEIs, ARBs Might Worsen COVID-19 Symptoms

In light of some new studies, patients on angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) might become increasingly concerned that their medications could make it harder for them to survive COVID-19. How should pharmacists answer their questions. A recent journal article explains the issue and calls for further research.

NEW ORLEANS — Could use of common cardiovascular drugs be a factor in the severe lung severe lung complications being diagnosed in some COVID-19 patients?

That was the question raised in a manuscript published online in the Journal of Travel Medicine.

The author from LSU Health New Orleans School of Public Health, James Diaz, MD, MHA, MPH, Dr PH. points out that the Severe Acute Respiratory Syndrome (SARS) beta coronaviruses, SARS-CoV, which caused the SARS outbreak in 2003 and the new SARS-CoV-2, which causes COVID-19, bind to angiotensin converting enzyme 2 (ACE2) receptors in the lower respiratory tracts of infected patients to get into the lungs. After 10-14 days, viral pneumonia and potentially fatal respiratory failure can occur in susceptible patients.

“Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are highly recommended medications for patients with cardiovascular diseases including heart attacks, high blood pressure, diabetes and chronic kidney disease to name a few," Diaz explained "Many of those who develop these diseases are older adults. They are prescribed these medications and take them every day."

That could be a problem because past research has demonstrated an increase in the number of ACE2 receptors in the cardiopulmonary circulation after intravenous infusions of ACE inhibitors, he said, adding, "Since patients treated with ACEIs and ARBS will have increased numbers of ACE2 receptors in their lungs for coronavirus S proteins to bind to, they may be at increased risk of severe disease outcomes due to SARS-CoV-2infections.”

While only a hypothesis, Diaz suggests it is supported by a recent descriptive analysis of 1,099 patients with laboratory-confirmed COVID-19 infections treated in China during the reporting period, Dec. 11, 2019, to Jan. 29, 2020. More severe disease outcomes were documented in patients with hypertension, coronary artery disease, diabetes and chronic renal disease; Diaz noted that all patients with the diagnoses noted met the recommended indications for treatment with ACEIs or ARBs.

He added that children might be protected from COVID-19 because have cross-protective antibodies from multiple upper respiratory tract infections caused by the common cold-causing alpha coronaviruses, as well as fewer ACE2 receptors in their lower respiratory tracts to attract the binding S proteins of the beta coronaviruses.

While recommending more research into the issue, he cautioned that patients “treated with ACEIs and ARBs for cardiovascular diseases should not stop taking their medicine, but should avoid crowds, mass events, ocean cruises, prolonged air travel, and all persons with respiratory illnesses during the current COVID-19 outbreak in order to reduce their risks of infection."

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