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FAQs - Practical issues for patients taking ACEI or ARBs > Should patients alter their use of ACEI or ARBs during the pandemic?

Should patients alter their use of ACEI or ARBs during the pandemic?

posted on 8:48 PM, May 12, 2020

No. There is no evidence that patients taking ACEI or ARBs are at increased risk of COVID-19 infection or increased disease severity although direct comparative data is currently limited by small numbers. ACE2 enzymes are potentially upregulated by ACEI, ARBs, and NSAIDs. This enzyme also serves as a binding site for the S protein of SARS-CoV-2 virus, allowing viral entry into cells by endocytosis. Based on this fact and the identified higher mortality in COVID-19 patients with chronic conditions such as diabetes, coronary artery disease and hypertension, some have suggested that the common use of ACEI and ARBs in the treatment of these conditions – rather than the chronic medical conditions themselves – were a culprit. However, current evidence does not support this contention. Conversely, professional societies including the American College of Cariology and the American Heart Association (ACC/AHA) and the Heart Failure Society of America have recommended that patients continue their use of ACEI and ARBs in order to control their underlying hypertension and preserve the end-organ (heart, kidney) benefits that have been demonstrated with these drug classes.

 

REFERENCES:

Brett AS, Rind DM. ACE inhibitors and ARBs during the COIVD-19 pandemic. NEJM 2020. Accessed May 12, 2020 at: https://www.jwatch.org/na51345/2020/04/09/ace-inhibitors-and-arbs-during-covid-19-pandemic

 

Liu Y, Huang F, Xu J, Yang P, Qin Y, et al. Anti-hypertensive Angiotensin II receptor blockers associated to mitigation of disease severity in elderly COVID-19 patients. BMJ medRxiv preprint 2020. Accessed May 12, 2020 at: https://www.medrxiv.org/content/10.1101/2020.03.20.20039586v1

 

Patel AB, Verma A. JAMA 2020;323(18):1769-1770. Accessed May 12, 2020 at: https://jamanetwork.com/journals/jama/fullarticle/2763803

 

Sparks MA, Hiremath S, et al. The coronavirus conundrum: ACE2 and hypertension edition. NephJC 2020 – last updated May 4, 2020. Accessed May 12, 2020 at: http://www.nephjc.com/news/covidace2