Chronic use of heart disease medications may increase the risk of severe COVID-19

A researcher has proposed that chronic use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may be responsible for the severe lung complications seen in some people diagnosed with COVID-19.

The Severe Acute Respiratory Syndrome (SARS) beta coronaviruses, SARS-CoV, including the new SARS-CoV-2, which causes COVID-19, bind to angiotensin converting enzyme 2 (ACE2) receptors in the lower respiratory tracts of to gain entry into the lung tissue. Once sequestered in the cells, viral pneumonia and potentially fatal respiratory failure may result in susceptible persons after 10-14 days.

“Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are highly recommended medications for patients with cardiovascular diseases including heart attacks, high blood pressure, diabetes and chronic kidney disease to name a few,” said Dr James Diaz, Professor and Head of Environmental Health Sciences at Louisiana State University Health Sciences Center, New Orleans School of Public Health, US. “Many of those who develop these diseases are older adults. They are prescribed these medications and take them every day.”

According to Dr Diaz, experimental models treated with ACEI intravenous infusions have shown increased numbers of ACE2 receptors in the cardiopulmonary circulation.

“Since patients treated with ACEIs and ARBS will have increased numbers of ACE2 receptors in their lungs for coronavirus Spike (S) proteins to bind to, they may be at increased risk of severe disease outcomes due to SARS-CoV-2infections,” explained Dr Diaz.

He also noted that his hypothesis was supported by the analysis of data from 1,099 patients with laboratory-confirmed COVID-19 infections treated in China. This study reported more severe disease outcomes in patients with hypertension, coronary artery disease, diabetes and chronic renal disease; all of the patients with these diagnoses noted met the recommended indications for treatment with ACEIs or ARBs.

Dr Diaz stated that further case-control studies in patients with COVID-19 infections would be needed to confirm that chronic therapy with ACEIs or ARBs may raise the risk of severe respiratory outcomes.

For the meantime he cautioned: “Patients treated with ACEIs and ARBs for cardiovascular diseases should not stop taking their medicine, but should avoid crowds, mass events, ocean cruises, prolonged air travel and all persons with respiratory illnesses during the current COVID-19 outbreak in order to reduce their risks of infection.”

The study was published in the Journal of Travel Medicine.