News | Coronavirus (COVID-19) | March 16, 2020| Dave Fornell, Editor

ESC Council on Hypertension Says ACE-I and ARBs Do Not Increase COVID-19 Mortality

The European Society of Cardiology (ESC) is recommending in novel coronavirus (COVID-19) patients not discontinuing angiotensin converting enzyme inhibitors (ACE-i) or angiotensin receptor blockers (ARBs) used to control hypertension. 

March 16, 2020 — The European Society of Cardiology (ESC) issued a statement March 13 recommending in novel coronavirus (COVID-19, and now clinically referred to as SARS‐CoV‐2) patients not discontinuing angiotensin converting enzyme inhibitors (ACE-i) or angiotensin receptor blockers (ARBs) used to control hypertension

Despite some early report theorizing these drugs might play a role to increase COVID-19 mortality, the Council on Hypertension of the ESC pointed out the lack of any evidence supporting harmful effect of ACE-I and ARB in the context of the pandemic COVID-19 outbreak.

According to case fatality rates reported by the American College of Cardiology (ACC) in COVID-19 patients, comorbid patients have materially higher than the average population. The ACC said hypertension elevates patient mortality risk to 6 percent. Read more on ACC COVID-19 recommendations for the cardiovascular care team.

The Council on Hypertension strongly recommends that physicians and patients should continue treatment with their usual anti-hypertensive therapy because there is no clinical or scientific evidence to suggest they cause any harm in COVID-19 infections.

Based on initial reports on COVID-19 patients in China and subsequent evidence since the outbreak, arterial hypertension may be associated with increased risk of mortality in hospitalized COVID-19 infected subjects. There was a hypothesis  suggesting this might be a potential adverse effect of ACE-i or ARBs. 

"It has been suggested, especially on social media sites, that these commonly used drugs may increase both the risk of infection and the severity of SARS-CoV2," explained Prof. Giovanni de Simone, chair of the ESC Council on Hypertension, who wrote the statement. "The concern arises from the observation that, similar to the coronavirus causing SARS, the COVID-19 virus binds to a specific enzyme called ACE2 to infect cells, and ACE2 levels are increased following treatment with ACE-i and ARBs." 

ESC said in the statement that because of the social media-related amplification, patients taking these drugs for their high blood pressure and their doctors have become increasingly concerned, and, in some cases, have stopped taking their ACE-I or ARB medications.

"This speculation about the safety of ACE-i or ARB treatment in relation to COVID-19 does not have a sound scientific basis or evidence to support it. Indeed, there is evidence from studies in animals suggesting that these medications might be rather protective against serious lung complications in patients with COVID-19 infection, but to date there is no data in humans," he said.

"There has been a lot of talk about the molecular and pathophysiology basis of the virus being mediated by the ACE-II receptors," said Thomas Maddox, M.D., MSc, FACC, the chairman of the American College of Cardiology (ACC) Science and Quality Committee, which recently created the ACC document on novel coronavirus (COVID-19) clinical guidance for the cardiovascular care team. "They are primarily in the lung, and that is why many people obviously have the pulmonary symptoms that are showing, but we know they are in the heart and intestine as well. We have started hearing reports of patients both domestically [in the U.S.] and overseas where they started to show signs of recovery from the lung disease and then all of a sudden appear to develop myocarditis or cardiomyopathy, and in some cases it is fatal."

He explained there was thinking that in the the expression of ACE-IIs, ACE-I inhibitors or ARBs might be able to inhibited the viral transport into the cells. However, the mechanisms behind the interactions of ACE-II and the ACI-Is and ARBs is very complex and there is no clear evidence that these drugs help inhibit, or aid the disease.

Read the related article COVID-19 Hydroxychloroquine Treatment Brings Prolonged QT Arrhythmia Issues.

This includes some background information on the ACE receptors — VIDEO: The Latest Data on COVID-19 and Cardiovascular Disease

Watch the VIDEO: What Cardiologists Need to Know about COVID-19 — Interview with Thomas Maddox, M.D., which discusses this subject in more detail.

Watch the VIDEO: Cancelling Non-essential Cardiac Procedures During the COVID-19 Outbreak — an interview with SCCT President Ehtisham Mahmud, M.D.,

For more information: https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang

 

Related Cardiology Related COVID-19 Content:

Statins May Reduce COVID-19 Severity

First Randomized Trial Backs Safety of ACE and ARB Heart Drugs in COVID-19 Patients

No Evidence Supporting Discontinuing RAAS Inhibitors in COVID-19 Patients

 

ACC COVID-19 recommendations for the cardiovascular care team

VIDEO: What Cardiologists Need to Know about COVID-19 — Interview with Thomas Maddox, M.D.

The Cardiac Implications of Novel Coronavirus

ESC Council on Hypertension Says ACE-I and ARBs Do Not Increase COVID-19 Mortality

VIDEO: Imaging COVID-19 With Point-of-Care Ultrasound (POCUS)

 

CT Provides Best Diagnosis for Novel Coronavirus (COVID-19)

Radiology Lessons for Coronavirus From the SARS and MERS Epidemics

Deployment of Health IT in China’s Fight Against the COVID-19 Epidemic

Emerging Technologies Proving Value in Chinese Coronavirus Fight

Radiologists Describe Coronavirus CT Imaging Features

 

Coronavirus Update from the FDA

CT Imaging of the 2019 Novel Coronavirus (2019-nCoV) Pneumonia

CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV)

Chest CT Findings of Patients Infected With Novel Coronavirus 2019-nCoV Pneumonia 

 

Additional COVID-19 Resources for Clinicians:

   ACC COVID-19 Hub page   

   Johns Hopkins Coronavirus Resource Center with inteavtive map of cases in U.S. and worldwide 

   World Health Organization (WHO) COVID-19 situation reports

   World Health Organization (WHO) coronavirus information page

   U.S. Food and Drug Administration (FDA) COVID-19 information page

   Centers for Disease Control (CDC) COVID-19 information page

   Centers for Medicare and Medicaid Services (CMS) frequently asked questions and answers (FAQs) for healthcare providers regarding COVID-19 related payments

Related Content

COVID-19 Positive STEMI Patients Have Higher Mortality, First data presented at #TCT2020 on COVID heart attack patients.

Getty Images

News | Coronavirus (COVID-19) | October 14, 2020
October 14, 2020 – The first outcomes data from the...
Very ill COVID-19 patients have a high rate of in-hospital sudden cardiac arrest and a very low survival rate.

Very ill COVID-19 patients have a high rate of in-hospital sudden cardiac arrest and very low survival rates. Getty Images

Feature | Coronavirus (COVID-19) | October 02, 2020
October 2, 2020 — Even when a sudden cardiac arrest happens inside a top hospital, where a code blue team is readily

An ECMO procedure at Tufts Medical Center in Boston. The FDA cleared the use of ECMO support for COVID-19 patients in April 2020. A new review of patients treated with ECMO showed it had positive outcomes in the most severe COVID-19 patients. Photo by Dave Fornell

News | Coronavirus (COVID-19) | September 29, 2020
September 29, 2020 –  Extracorporeal mem...
hort-term hydroxychloroquine treatment is not associated with lethal heart rhythms in patients with COVID-19 (SARS-CoV-2) who are risk assessed prior to receiving the drug. That is the finding of research published today in EP Europace, a journal of the European Society of Cardiology (ESC). #COVID19 #SARSCoV2 #hydroxychloroquine
News | Coronavirus (COVID-19) | September 25, 2020
September 25, 2020 — Short-term hydroxychloroquine treatment is not associated with lethal heart rhythms in patients
SARS-CoV-2 infection of cells shown in green, left. This is inhibited by a modified form of cholesterol called 25-hydroxycholesterol (25HC), as seen in the cells in the right image. 25HC activates an enzyme called ACAT, found inside cells in the endoplasmic reticulum. ACAT then depletes accessible cholesterol on the cell’s membrane. It is a normally occurring process that gets kicked into high gear during some viral infections. Image from UC San Diego Health Sciences.

SARS-CoV-2 infection of cells shown in green, left. This is inhibited by a modified form of cholesterol called 25-hydroxycholesterol (25HC), as seen in the cells in the right image. 25HC activates an enzyme called ACAT, found inside cells in the endoplasmic reticulum. ACAT then depletes accessible cholesterol on the cell’s membrane. It is a normally occurring process that gets kicked into high gear during some viral infections. Image from UC San Diego Health Sciences.

News | Coronavirus (COVID-19) | September 24, 2020
September 24, 2020 — Analyzing anonymized patient medical records,...
COVID-19 Therapy Drug Azithromycin May Increase Risk for Cardiac Events

Getty Images

News | Coronavirus (COVID-19) | September 17, 2020
September 17, 2020 — Debates over whether hydroxychloroquine should be taken to help lessen the duration and impact o