Blood Pressure Drugs’ effect on COVID-19

ACE inhibitors help proteins that attach coronavirus

ACE Inhibitors

ACE Inhibitors

The most popular blood-pressure medications used in the US today contain a mechanism of action that appears to increase the amounts of a protein the coronavirus uses to attach to the body’s lung cells to hijack them and multiply.

In 2009, ACE inhibitors were the fourth most utilized drug class in the US with 162.8-million prescriptions and ARBs the eleventh most at 82.5 million, according to a 2010 report in the November/December issue of the Journal of Managed Care Pharmacy.

What Is An ACE Inhibitor?

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB)s are the most widely used drugs in the treatment of hypertension and heart failure. Since so many patients also have diabetes, their use is often in combination with drugs for this disease. It is thought this may account for the greater risk that persons with high-blood pressure and diabetes appear to be at for infection with the coronavirus. These drugs work by increasing amounts of angiotensin converting enzyme 2 (ACE2), which is attached to the outer surfaces of the cell membrane in the lungs, arteries, heart, kidney, and intestines. ACE2 counters the effects of ACE by increasing amounts of angiotensin II. It does so by cleaving this peptide from angiotensin, another peptide that constricts the arteries.

Is Good Bad?

That’s all good for you, which is why these drugs lower one’s BP. But because ACE2 is found on the outer surfaces of the cells’ membranes and happens to also serve as an easy attachment point for coronarivuses including COVID-19.

“We understand the concern—as it has become clear that people with cardiovascular disease are at much higher risk of serious complications including death from COVID-19,” American Health Association president Robert A. Harrington, MD, told the media. “However, we have reviewed the latest research—the evidence does not confirm the need to discontinue ACE [inhibitors] or ARBs, and we strongly recommend all physicians to consider the individual needs of each patient before making any changes to ACE [inhibitors) or ARB treatment regimens.”

In fact, most doctors writing in the medical journals at this time are questioning to what extent the risk is increased, if at all. In addition, it would seem, that healthy persons with optimal ACE2 expression would also be at risk. In other words, without some kind of evidence, whether experimental or clinical, the consensus is that the risks of switching someone’s drug regimen would be greater than that of the virus itself.

Writing in the March 2020 issue of Hypertension, a research team observes that there are no data to support the notion that ACE inhibitor or angiotensin II type 1 receptor blocker administration facilitates coronavirus entry by increasing ACE2 expression in either animals or humans.i

On the other hand, they say, “animal data support elevated ACE2 expression as conferring potential protective pulmonary and cardiovascular effects. In summary, based on the currently available evidence, treatment with renin-angiotensin system blockers should not be discontinued because of concerns with coronavirus infection.”

That is because the risk of a heart attack or stroke could be far greater in the population comparing to the number of deaths the virus would have caused.

The editorials don’t mention healthy life styles. Yet, users of such drugs should probably focus on increasing their immune competence and health as yielding greater results than making any sudden switches.

The verdict now seems to be don’t stop your regimen just because of the coronavirus.

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