Hypothesis on ACE Inhibitors, Angiotensin Receptor Blockers, and Severe COVID-19 Risk

Overview of ACE Inhibitors and Angiotensin Receptor Blockers

ACE inhibitors and angiotensin receptor blockers (ARBs) are widely prescribed cardiovascular medications. They are utilized to manage various health conditions, including high blood pressure, heart disease, diabetes, and chronic kidney disease. Recent studies suggest that these medications may be linked to an increased risk of severe COVID-19 in patients who contract the virus.

Research Findings

A recent article in the *Journal of Travel Medicine* features research from U.S. scientists proposing that the chronic use of ACE inhibitors and ARBs may elevate the risk of severe COVID-19 and its complications. Both SARS-CoV, responsible for the 2003 SARS outbreak, and the current SARS-CoV-2 virus, which causes COVID-19, utilize similar mechanisms to infiltrate lung tissues. This can result in serious respiratory issues, including viral pneumonia and respiratory failure within a span of 10 to 14 days for susceptible individuals.

Mechanism of Action

Animal studies indicate that long-term usage of ACE inhibitors and ARBs can increase the number of ACE2 receptors in the body. These receptors serve as entry points for the spike (S) proteins of beta coronaviruses. The binding of S proteins to ACE2 receptors in the lower respiratory tract facilitates the virus’s entry into lung tissues, potentially heightening the risk of severe outcomes in patients using these medications.

Supporting Evidence from Clinical Studies

A descriptive analysis conducted in China examined 1,099 patients with laboratory-confirmed COVID-19 diagnoses. The study found that severe outcomes were more prevalent among individuals with comorbid conditions—such as high blood pressure, heart disease, kidney disease, and diabetes—that typically necessitate the use of ACE inhibitors and ARBs. Notable severe outcomes included ICU admissions, the need for mechanical ventilation, and mortality. Elderly patients, who are more likely to have these comorbidities and to be prescribed ACE inhibitors or ARBs, are particularly vulnerable to severe COVID-19 infections.

Future Research Directions

Further case-control studies are essential to substantiate the hypothesis that the use of ACE inhibitors and ARBs is a risk factor for more severe COVID-19. As our understanding of COVID-19 evolves, ongoing research will be crucial in clarifying the implications of these medications.

Precautionary Measures

It remains vital for all individuals, including those taking ACE inhibitors or ARBs, to take proactive measures to mitigate their risk of COVID-19 infection. Recommended precautions include avoiding crowded places, large events, air travel, and cruises, as well as minimizing contact with individuals exhibiting respiratory illness symptoms.

Author Information

Written by Maggie Leung, PharmD.

Additional Resources

For a range of personal protective equipment, visit www.medofsupply.com.

References

Diaz, J. H. (2020). Hypothesis: angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may increase the risk of severe COVID-19. *Journal of Travel Medicine*. doi: 10.1093/jtm/taaa041
ACE inhibitors and angiotensin receptor blockers may increase the risk of severe COVID-19. (2020, March 23). Retrieved from https://www.eurekalert.org/pub_releases/2020-03/lsuh-aia032120.php
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