Do High Blood Pressure Drugs Increase Your Coronavirus Risk?
Heart experts discuss whether certain drugs for high blood pressure and other cardiovascular diseases increase the risk of Covid-19.
Remember when people were worried whether ibuprofen might make Covid-19 symptoms worse? It doesn’t, but the concern sparked a lesser-known debate.
This one is about whether blood pressure drugs known as angiotensin-converting enzyme (ACE) inhibitors and angiotensin II type-I receptor blockers (ARBs) increase the risk for Covid-19.
These are popular drugs, and people take them not only for high blood pressure but for heart attacks, heart failure, and complications from diabetes (which increases the risk for heart disease). There are many different ACE inhibitors available in the U.S., and they include drugs like ramipril (Altace), enalapril (Vasotec), captopril (Capoten), and lisinopril (Qbrelis). There are also many types of ARBs and they include drugs like losartan (Cozaar) and olmesartan (Benicar).
For now, the message to people who are taking either type of these potentially life-saving medications is to continue to take them. “If you are taking one of these medications because you have an indication, you should continue,” says Oscar Cingolani, MD, director of the hypertension program and associate professor of medicine at Johns Hopkins Medicine in Baltimore.
If you’re planning to start on one of these medications, talk to your doctor, adds Dr. Cingolani. The American College of Cardiology (ACC) and American Heart Association (AHA) is reviewing the information on a daily basis, he says. Here are other ways Covid-19 is affecting heart health.
The origins of the controversy
The debate stems partly from a March 2020 correspondence in The Lancet which suggests that people on ACE inhibitors and ARBs, may have a higher risk of Covid-19 infection or of severe illness or even death.
“Much of the concern is based on The Lancet piece as well as theoretical data based on animal studies that suggest that high levels of the enzyme angiotensin-converting enzyme 2 (ACE2), which the virus uses to penetrate and infect human cells, is higher if you take these drugs,” says Dr. Cingolani. But, he adds, “there are no experimental or clinical data demonstrating beneficial or adverse outcomes among people using ACE inhibitors, ARBs, or other medications with similar action.” Since the original correspondence, follow up correspondence from The Lancet refutes the original hypothesis.
What recent research says
A study from Stanford Medicine researchers published in the journal Nature Communications in October of 2020 found that hypertension drugs probably don’t increase the risk of Covid-19 infection. They also found that the coronavirus likely first enters the body through cells in the nasal passages and upper airways.
This is important because the coronavirus enters human cells by ACE2. “Past studies have found that the use of ACE inhibitors for hypertension increases the expression of ACE2 in the kidney and heart,” says Ivan Lee, MD, PhD, an instructor of allergy and immunology and one of the co-lead authors of the study. The researchers found that ACE2 levels in the upper airways, however, did not vary significantly between those people taking blood pressure medications and those who were not.
Another meta-analysis published in August 2020 in Current Atherosclerosis Reports looked at 19 different studies on the topic of blood pressure drugs and Covid-19. The study actually suggests that long-term use of the medications could reduce infection severity and improve survival in people with Covid-19.
They found that hypertensive patients with Covid-19 who were on high blood pressure drugs were less likely to die or become critically ill than patients with hypertension who were not taking them. Note that the study did not investigate the impact of giving these drugs to other patients with Covid-19 who are not already taking them.
Don’t stop taking high blood pressure drugs
On March 17, 2020, in a joint statement, the ACC, AHA, and the Heart Failure Society of America urged patients on these medications not to change their regimen, unless instructed by a doctor. If anyone with cardiovascular disease is diagnosed with Covid-19, then doctors need to make decisions based on the patient’s individual factors, according to the statement. A more recent statement from the ACC from July 2020 still stands by this recommendation.
If the pandemic indeed lasts for a long time and people interrupt their medication, “a lot of people are going to suffer from aggravated heart failure or stroke,” says Dr. Cingolani. It’s important to remember that other health conditions are still a risk during this pandemic.
katleho Seisa/Getty ImagesHigh blood pressure does increase Covid-19 risk
Whether or not they are taking ACE inhibitors or ARBs, people with underlying conditions, including diabetes, hypertension, and coronary heart disease, are already at higher risk for becoming severely ill or dying from coronavirus. Furthermore, patients with cardiovascular disease are already susceptible to respiratory infections.
A report in the China Centers for Disease Control (CDC) Weekly found that the highest mortality rate was among people 80 and over (14.8%). The next highest rate (10.5%) was among people with cardiovascular disease, followed by diabetes (7.3%), chronic respiratory disease (6.3%), hypertension (6%), and cancer (5.6%). Even absent a pandemic, these same patients are at a higher mortality risk, period. “The more risk factors that you have, the more you’re likely to do badly with any disease,” says Dr. Cingolani.
How to protect yourself against Covid-19
There are a few things you can do to prevent contracting coronavirus, whether you take drugs for high blood pressure or not. Wear a mask in public to protect both yourself and others. Wash your hands frequently with soap and water. If that’s not available, use hand sanitizer. Cover your coughs and sneezes with your elbow, sanitize surfaces in your home, and isolate yourself if you have symptoms. Limit contact with people who have symptoms and even people who don’t have symptoms, says the CDC. That’s because the virus can spread even if a person has no outward signs like a cough, fever, or shortness of breath. (Here are other ways to prevent coronavirus.)
- Oscar Cingolani, MD, director, hypertension program and associate professor of medicine, Johns Hopkins Medicine, Baltimore
- Lancet Respiratory Medicine: "Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?"
- American College of Cardiology: "HFSA/ACC/AHA Statement Addresses Concerns Re: Using RAAS Antagonists in COVID-19"
- China Centers for Disease and Prevention Weekly: "Vital Surveillances: The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) — China, 2020"
- CDC: "Get Ready for COVID-19"
- The Lancet: "Antihypertensive drugs and risk of COVID-19?"
- Nature Communications: "ACE2 localizes to the respiratory cilia and is not increased by ACE inhibitors or ARBs"
- Current Atherosclerosis Reports: "Effect of Renin-Angiotensin-Aldosterone System Inhibitors in Patients with COVID-19: a Systematic Review and Meta-analysis of 28,872 Patients"
- American College of Cardiology: "COVID-19 and Hypertension: What We Know and Don't Know"