Researchers hypothesize why patients taking ACE inhibitors and angiotensin receptor blockers may be at a higher risk of severe COVID-19.
ACE inhibitors and angiotensin receptor blockers are cardiovascular medications commonly used to treat a variety of diseases, including high blood pressure, heart disease, diabetes, and chronic kidney disease. However, early research indicates that these drugs may contribute to an increased risk of severe COVID-19, should patients taking these medications become infected with the novel COVID-19 virus. In a recent article published in the Journal of Travel Medicine, researchers from the United States hypothesize that the use of ACE inhibitors and angiotensin receptor blockers may be putting these patients at risk of severe COVID-19 and its associated complications.
The beta coronavirus, SARS-CoV, that caused the 2003 outbreak of SARS (severe acute respiratory syndrome) outbreak and the related beta coronavirus, SARS-CoV-2, that causes the novel COVID-19 disease both have the same mechanism of action to invade and infiltrate the lungs. For patients who are susceptible, this can lead to the development of viral pneumonia and respiratory failure within 10 to 14 days.
Early animal studies have shown that the chronic use of ACE inhibitors and angiotensin receptor blockers increases the number of ACE2 receptors circulating in the body. Unfortunately, ACE2 receptors are also binding sites for the S proteins found on the surface of beta coronaviruses. Both coronaviruses that cause SARS and COVID-19 have S proteins that bind to ACE2 receptors in the lower respiratory tract, allowing the virus to then enter into the lungs. As a result, patients who take ACE inhibitors and angiotensin receptor blockers chronically may be at a heightened risk of severe COVID-19 and poorer outcomes due to complications related to the infection.
This explanation is supported by a recent descriptive analyses study done in China on 1099 patients who had a laboratory-confirmed positive diagnosis of COVID-19. The study revealed that more severe outcomes from COVID-19 were seen in patients who suffered from comorbid conditions that all have indications for the use of ACE inhibitors and angiotensin receptor blockers, such as high blood pressure, heart disease, kidney disease and diabetes. Severe outcomes included admission into the intensive care unit (ICU), requirement of mechanical ventilation and death. In particular, elderly patients are the more vulnerable population group as they are more likely to suffer from these comorbid conditions and be taking ACE inhibitors and angiotensin receptor blockers, therefore putting them at a higher risk of contracting a severe and potentially fatal COVID-19 infection.
Future case-control studies are needed to further confirm the hypothesis that ACE inhibitor and angiotensin receptor blocker use are risk factors for more severe COVID-19 disease, especially as information continues to evolve amidst the COVID-19 global outbreak. Nonetheless, it is important for all people, including patients taking ACE inhibitors or angiotensin receptor blockers, to take necessary precautions to reduce their risk of contracting a COVID-19 infection. This includes avoiding crowds, large events, air travel, ocean cruises and contact with other people who are presenting with respiratory illness symptoms.
Written by Maggie Leung, PharmD.
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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