HOT OFF THE PRESS: ARBs and ACE-Is may be Protective against COVID-19 Infection

25 April 2020

Further to my article (here), there is now reassuring clinical data which show taking ARBs (angiotensin receptor blockers) or ACE-Is (angiotensin converting enzyme inhibitors) doesn’t impose further risk of severity and complications of COVID-19 infection, but rather may improve chances of surviving the disease.

A study(1) on 1,128 patients with a history of high blood pressure (in Wuhan who were admitted with COVID-19) recently published by Circulation Research showed those on ARBs or ACE-Is blood pressure medications (188 patients) had close to a 60% lower rate of death and a 68% lower risk of septic shock compared to those who were not on these meds.

Another study(2) published by JAMA Cardiology on 326 patients (mean age = 66) from a single centre (The Central Hospital of Wuhan) with hypertension and COVID-19 infection requiring hospitalisation, showed no difference in rate of disease severity, complication rate and risk of death in those who were taking ACEIs/ARBs compared with those not treated with these medications.

These two studies buttressed the results of other recent studies from Shenzhen(3) and the UK(4) which showed taking ARBs or ACE-Is appeared to be protective against and is associated with less severe COVID-19 infections.

Take home message:

Study results from various geographic locations are thus far reassuring for patients taking ARB or ACE-I medications. These medications are unlikely to worsen or carry a higher risk of complications for COVID-19 infections and may in fact be protective and improve chances of surviving the disease.

ARB medications all end with sartan: Olmesartan, Valsartan, Candesartan, Losartan, Telmisartan, Irbesartan, Azilsartan.

ACE-I medications all end with pril: Perindopril, Ramipril, Trandolapril, Quinapril, Benazepril, Captopril, Enalapril, Fosinopril, Lisinopril, Moexipril.

References:

1. Association of Inpatient Use of Angiotensin Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers with Mortality Among Patients with Hypertension Hospitalized With COVID-19. Zhang P et al. Circ Res 2020. DOI: 10.1161/CIRCRESAHA.120.317134.

2. Association of Renin-Angiotensin System Inhibitors with Severity or Risk of Death in Patients With Hypertension Hospitalized for Coronavirus Disease 2019 (COVID-19) Infection in Wuhan, China. Li J et al. JAMA Cardiology 2020 doi:10.1001/jamacardio.2020.1624.

3. Renin-angiotensin system inhibitors improve the clinical outcomes of COVID-19 patients with hypertension. Meng J et al. Emerging Microbes & Infections 2020. doi.org/10.1080/22221751.2020.1746200.

4. Treatment with ACE-inhibitors is associated with less severe disease with SARS-Covid-19 infection in a multi-site UK acute Hospital Trust. Bean D et al. medRxiv preprint 2020. doi.org/10.1101/2020.04.07.20056788.