Blood pressure meds won’t make COVID-19 worse

Some patients have been expressing concerns to doctors after the idea started circulating on social media that two common hypertension (high blood pressure) drugs could lead to more severe cases of COVID-19.

However, a high-powered group of doctors and scientists in Aotearoa New Zealand have scrutinised the evidence for this theory and determined it is weak and should be disregarded.

The Specialist Hypertension Research Network of the North Island of Aotearoa has released a consensus statement, endorsed by Heart Foundation Medical Director and University of Auckland Associate Professor Gerry Devlin, and Heart Foundation Chair, University of Auckland Professor Rob Doughty. It recommends patients keep taking their blood pressure medications as prescribed by their doctors, in line with the latest expert advice from international specialist bodies.

One of the statement authors is University of Auckland Professor Julian Paton, Director of Manaaki Mānawa – The Heart Research Centre. “Scientists around the world are racing right now to gather and make sense of COVID-19 data,” he says. “Inevitably, there will be some false starts, some dead ends. Going by the best evidence available right now, this seems to be one of them.”

The source of the idea was speculation made by several scientists in letters to prominent medical journals, BMJ and Lancet Respiratory Medicine. The scientists had noticed that COVID-19 patients with existing conditions such as hypertension and diabetes had more severe symptoms. They suggested this might be because a class of drugs used for both conditions, called renin-angiotensin-aldosterone system inhibitors, can increase levels of an enzyme (ACE2), which is used by the COVID-19 virus to gain entry to the body’s cells. Two such drug classes commonly used for hypertension in New Zealand are known as ACE inhibitors and ARB.

But the studies from China on which they based this speculation did not rule out the possibility that the more severe symptoms reflected other ‘confounding factors’ such as age, the New Zealand experts note. The patients with severe COVID-19 disease in those studies were much older than those with milder disease. Nor did the studies actually record what hypertension drugs the patients were taking or for how long; just that they had high blood pressure.

In fact, the New Zealand experts also point to early evidence that ACE inhibitors may even offer some protection from some viral pneumonias. “Based on this, there are on-going trials studying the effect of Losartan (an ARB) in patients with COVID-19 in outpatient and inpatient settings [in the US]”, the statement says.

Another expert behind the statement is Dr Hari Talreja, a consultant renal physician at Counties Manukau Health and honorary senior lecturer in medicine at the University of Auckland. He says ACE inhibitors and ARBs are very useful drugs for treatment of not just hypertension but also kidney and heart diseases.

“Going off these medications for some unknown benefit could actually make these conditions worse,” he says. “Also, patients will need alternative drugs which may need more contact with the healthcare provider, pharmacy, and even laboratories. At a time when we need to practice physical distancing to avoid Coronavirus, this may end up being counter-productive.”

The consensus statement concludes: “given the available evidence, we DO NOT advise patients on ACE inhibitors or ARB to change therapy. These commonly used medications confer benefits in patients with cardiovascular disease, diabetes and kidney disease, and should not be changed unless clinically indicated. The current evidence on COVID-19 and hypertension, and ACE inhibitors or ARB medication is inadequately adjusted and prone to bias, and therefore remains inconclusive.”

Professor Paton: “At this time there is no direct evidence that ARBs and ACE inhibitors will increase COVID-19 infection or increase symptom severity through an ACE2 mechanism. Taking both animal and human data available, it is still unclear whether ARBs alter ACE2 protein expression.”