Truth behind COVID-19 and using antihypertensives

Investigations on safety of using ARBs and ACE inhibitors publish outcomes

COVID-19 prevalence and severity not affected by the medications

Although a hypertension treatment angiotensin-converting enzyme (ACE) inhibitor has aroused controversy while seeking for COVID-19 treatment, the drug’s safety issues is getting resolved by a series of related clinical investigations.

 

Multiple clinical trials of using ACE inhibitors on COVID-19 patients have confirmed the safety of the drug and actually discovered it helps patients fighting against COVID-19.

 

The safety concerns of using the antihypertensive and COVID-19 soon to be concluded According to medical scholars on May 5, safety concerns regarding the use of antihypertnesives amid COVID-19 pandemic has been raised early.

 

A series of clinical studies have been published confirming the correlations between COVID-19 and antihypertensive ACE inhibitors

Because the novel coronavirus uses ACE, especially ACE2, as a receptor to spread, some medical experts argued angiotensin II receptor blockers (ARBs) and ACE inhibitors could possibly worsened the disease condition.

 

And an animal study result supported the theory as it found ARBs and ACE inhibitors upregulating the expression of ACE2, and hence, allow the virus to more actively invade lungs and heart, where ACE2 is expressed.

 

Although internationally renowned medical organizations like World Congress of Cardiology (WCC), American College of Cardiology (ACC) and European Society of Cardiology (ESC) have urged the prescribers to maintain the prescription of the medications as suspending the treatment would cause more damage than benefit, the medical experts are still arguing over the issue.

 

This is the background behind why so many COVID-19 related clinical trials around the world are testing the safety of using the hypertension treatments.

 

In conclusion, however, the concerning theory was proven groundless.

 

Three studies have already concluded in same findings—the hypertension treatments ‘do not affect COVID-19 patients at all.’ Safety test results on ACE inhibitors report “suspending prescription is more dangerous” A multiregional multicenter study led by Professor Yun Feng of Jiao Tong University at Shanghai found that halting the prescription of the hypertension drugs could threatened the patients with hypertension even worse (doi.org/10.1164/rccm.202002-0445OC).

 

Clinical trials reported so far have refuted the claim that ARBs and ACE inhibitors affect prevalence and severity of COVID-19

Running a head-to-head comparison trial on 476 COVID-19 patients, the researchers confirmed the patient group that halted the antihypertensive prescription showed higher possibility of worsening their condition.

 

In fact, only four out of 33 patients (12 percent) with hypertension who took ARB and ACE inhibitor have become severely ill, whereas 36 out of 80 patients (45 percent) who stopped taking the medications have become severely ill.

 

As a result, the study has proven that stopping the medication out of the concern could actually worsen the COVID-19 condition.

 

Another study also claims the concern over safety is baseless.

 

Comparing groups of patients either taking or not taking the antihypertensive and without comorbidity has shown no significant difference.

 

An investigation led by Professor Guang Yang of Hubei Provincial Academy of Traditional Chinese Medicine analyzed 126 patients with hypertension and 125 patients without the underlying condition, and also compared them to 1,942 patients who visited hospital prior to the spread of COVID-19 (doi.org/10.1101/2020.03.31.20038935).

 

Moreover, the researchers subdivided the patient group with hypertension either administered with ARB and ACE inhibitor or not, and compared the effect of using the drugs.

 

The study found 35.4 percent of hospitalized patients with hypertension before the spread of COVID-19 used ARB and ACE inhibitor and 34.1 percent of the patients after the spread of COVID-19 used the medications, which demonstrated no significant difference.

 

It also meant the concern of administering ARB and ACE inhibitor raised from the animal study is not meaningful in clinical terms (P=0.756).

 

In some cases, hospitalized patients with COVID-19 who were administered with ARB and ACE inhibitor showed lower severity level and mortality rate than the ones that did not take the medications.

 

But the figure did not have statistical meaning, and the researchers recommended interpreting the result to understand that the medications do not worsen the disease severity.

 

A study led by Professor Yingxia Liu at Southern University of Science and Technology of China also resulted in similar outcomes.

 

The investigators analyzed 78 COVID-19 patients with the hypertension comorbidity, and discovered the administration of ARB or ACE inhibitor did not affect prevalence or severity of the disease (doi.org/10.1101/2020.03.20.20039586).

 

24.3 percent of the study participants had taken ARB and 3.8 percent had been prescribed with ACE inhibitor.

 

But each group only had 15.8 percent and 2.6 percent of severe cases, respectively.

 

The study also saw the group that was prescribed with ARB and ACE inhibitor had lower severity in the disease than the group with hypertension but had not taken the drugs.

 

Compared to the control group, only 54 percent of the ARB-prescribed patient group had severe cases of COVID-19 and ACE inhibitor-prescribed group showed the similar result with 57 percent.

 

Large-scale clinical trials in preparation to “seek evidences for continuing prescription” Based on the study results refuting the claim of ACE inhibitors affecting the prevalence and severity of COVID-19, the international scholars’ clinical reasoning and recommendation to continue the antihypertensive medications would likely to be accepted more widely.

 

Medical experts anticipate these investigations would provide evidences supporting the medical scholars’ recommendations to continue prescribing the hypertension treatments

WCC, ACC, ESC and Korean Society of Hypertension (KSH) have urged on maintaining the prescription, but it was rather a clinical reasoning than from concrete evidence.

 

However, their recommendation is gaining more support as more and more clinical evidences are generated in continuous investigations on the matter.

 

Besides the published study results, there are large-scale randomized, double-blinded, head-to-head clinical trials in progress globally, and they would provide more concrete evidences in May.

 

A KSH official stated, “The already available study outcomes are sufficient enough to say ARB and ACE inhibitor prescription should be maintained,” but “the findings are only based on observational studies with limitation.

 

Regardless, the soon-to-be-published randomized double-blinded placebo-controlled studies would provide more clear direction.”