COVID-19 AND BLOOD PRESSURE MEDS?

There is no question that COVID-19 has turned our world upside down, and has remained the number 1 health concern for essentially all of us. However, we never doubted that certain classes of blood pressure medications would be suspect for worsening morbidity and mortality.

ACE inhibitors (eg. lisinopril, accupril, captopril, enalapril, benazepril,etc.) and ARBs or angiotensin receptor blockers ( losartan, valsartan, olmesartan, etc), are amongst the most commonly used meds for hypertension. They certainly constitute the most widely used meds in my cardiology practice. However, with the pandemic of Coronavirus COVID-19, these meds have recently come under scrutiny. 

Concern for these drugs grew out of recent observational Chinese data showing greater morbidity  and mortality among patients with hypertension who went on to develop COVID-19. However experts have come forth reporting that there was no adjustment for certain variables. The validity of the Chinese observation is clearly being questioned. The current consensus is that the data is simply not there. 

Most cardiologists, including myself do not recommend changing to other medications to control blood pressure; even in the presence of COVID-19. There is definite potential harm in doing so. Firstly, there is no simple formula in switching from one class of medications that have successfully controlled a patient’s blood pressure to a new class. Why go from a well-tolerated class and dose of a specific mediation to an unknown? This could easily lead to worsening blood pressure, or drug toxicities due to changing to an entirely different class. From my perspective, this is not a time to attempt trial and error. 

The other concern is losing the positive effects of ACEs and ARBs that are specific to this class of meds. These include preserving kidney function in those with diabetic kidney disease, and maintaining cardiac function in those with a history of congestive heart failure.

Fear of using these drugs stems from up-regulation of ACE2 receptors, possibly increasing viral entry into cells in the laboratory.  But we do not know the effect in the context of the human body.

In conclusion, we lack prospective data on the use of these commonly used Bp meds and their impact on COVID-19 patients. From the viewpoint of The Medical Advocate, I say stick with what works. 

Hypertension and cardiovascular disease remain the highest risk for mortality in those afflicted with COVID-19. Changing medications at such a vulnerable time is simply not recommended. It boils down to risks versus benefits. The potential risk of changing medications is outweighed by the benefits of remaining on these medications that clearly work .    

You can read the original article from TCTMD by clicking HERE.