Do blood pressure meds make us more vulnerable to Covid-19?

As if we don’t have enough to think about as people with diabetes during the coronavirus pandemic. I came across this issue published online on 11 March 2020 in the respected peer-reviewed publication, Lancet.

This piece has only proposed a hypothesis: ACE inhibitors (angiotensin coveting enzyme) and ARBs (angiotensin receptor blocker) make people who take them more receptive to catching and incubating the coronavirus.

This is a question that needs to be tested but if it’s shown to be true, then that may explain some of the reason why people with diabetes suffer a higher incidence of more extreme consequences of this virus.

I’ve been taking an ACE inhibitor or ARB blood pressure drug for 20 years or more but have been able to get off of them recently. I think many lifestyle changes that I’ve implemented in the last year or so have helped reduce my blood pressure. I still take a beta-blocker to keep my heart rate down.

https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(20)30116-8.pdf

I’ll be interested in your comments once you read this one-page report.

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I had been worried about this. My husband and I take Losartan and I have heart disease and well controlled type 1. We are also seniors. We will continue to go to extreme means to protect ourselves since we enjoy living.

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I hesitated to post this topic since we’ve been inundated with troubling health news recently. I prefer, however, to at least be aware of the facts. Not sure what people who depend on these drugs can do, however. Maybe considering some alternatives would be advisable.

Lifestyle changes might help some people. During the time I was able to wean myself off of my ARB, I was also using the sauna 5-6 days/week since last September. I’ve read that daily sauna usage can help reduce blood pressure but might not help everyone. I’ve now stopped using the sauna due to my concern with exposure to the coronavirus, especially in the locker-room.

I’ve also read that mindfulness practices, like meditation, can help alleviate high blood pressure.

My blood pressure was quite low when low carbing and I kept passing out and hitting my head. Now eating a low fat vegan diet, I have to take BP meds. My husband has always needed to take BP meds no matter what his diet.

Fascinating, Terry. Good research.

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

Seems that there is no basis to what you folks are saying?

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ooooh, more interesting stuff. Good work, everybody. Flu is endlessly interesting.

You say there is no basis for medical professionals to propose a hypothesis in a peer-reviewed publication. Do I understand you? Or are you disputing whether it is appropriate that I even take note of the publication of this source?

It seems like you misunderstand the content of what I posted. Are you saying that this question should not be posed? The source I cited raised this idea as a hypothesis, not a conclusion or answer to that question. A hypothesis is simply a question that forms the beginning of the scientific method.

@Christoph, you point to a medical professional association that appears to take the other side of this issue. Only a well constructed study can answer this question.

The Lancet is a respected peer-reviewed publication. The fact that this proposed hypothesis was published there makes me think that this is a serious question deserving more study.

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Right, it’s a hypothesis and it seems quite reasonable to me. They’re not telling everyone to stop taking their medication. People on social media might not understand this, but ACE2 expression does not decrease the minute you stop taking ACE inhibitors, but that might take quite some time. Stopping with ACE inhibitors therefore does not immediately decrease the risk of Covid-19 infection, while the blood pressure could rise much faster. That would make everything worse.
This hypothesis and the ESC Council statement don’t necessarily contradict each other. Two claims can be true at once: 1) ACE inhibitors increase the susceptibility to Covid-19 infection 2) ACE inhibitors might protect against serious lung complications.
Finally they suggest that calcium channel blockers might be a good alternative that doesn’t increase ACE2 expression.

Another article on the dependence of SARS-CoV2 on ACE2:
https://www.cell.com/cell/fulltext/S0092-8674(20)30229-4

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I’m not sure how you could double-blind the question you are asking, using existing data.

Folks who are taking ACE inhibitors/ARB’s already have high blood pressure and diabetes and maybe a couple other health conditions that cannot be untangled and seem to play big factors in the severity of a coronavirus infection. So getting at the actual cause/effect vs just plain correlation is gonna be hard.

As to actual infection rates - no country in the world has very good statistics about the actual number of folks infected. They are only reporting confirmed cases. I saw my endo on Wednesday and her estimate is that soon 60-70% of the population will have had coronavirus but only a fraction are going to be able to get a test. And younger/healthier folks will just ride it out no big deal without an official test, while those with health conditions that make it worse will be more likely to be actually get tested so this will further skew the stats you are talking about.

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I take an ARB and don’t have high blood pressure. Just as a kidney precaution and my doc has even asked me a few times if i even still want to take it.

I see no convincing evidence either way on this subject. One hypothesis says they may be harmful but there is not enough proof. The other say there is no proof of the hypothesis so no action is needed.

Sort of a catch 22 isn’t it? I don’t take an ACE inhibitor but if I did I would not stop it if it was needed to control BP. I wouldn’t give up a treatment for a known problem over an unproven hypothesis.

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I can only talk for myself , getting diabetes 28 years ago I have been on BP medication all these years. But being 67 I am in a susceptible age group to catch this. I am washing my hands. We live in a rural area so no crowds unless we go to the city for church. And that is maybe 120. Plus church is cancelled. Nancy50

Right. If I were on an ACEI or ARB, I would probably not stop it. I think it’s best to check with the doc. From what I’ve read of different studies, ACE inhibitors and ARBs result in upregulation of ACE2. I suppose this is a natural consequence of something flooding to block the receptors. On the other hand, the receptors are blocked! So, wouldn’t that be a good (ie preventative) thing? Hence the European study (I guess). Honestly, I don’t know.

I’ve also read that ACE2 can also be increased by ibuprofen and thiazolidinediones a class of diabetic medicines. Just passin along what I’ve read. If nothing else, it’s good to have this information out there - maybe now the patient information sheets of these medications, if found to indeed increase ACE2 receptors, can get updated with possible side effects: something like, this medication may make you more susceptible to certain viruses.

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I guarantee if we all stop breathing right now we will not die of the corona virus.

The most distinctive comorbidities of 32 non-survivors from a group of 52 intensive care unit patients with novel coronavirus disease 2019 (COVID-19) in the study by Xiaobo Yang and colleagues1 were cerebrovascular diseases (22%) and diabetes (22%).

I find this statement interesting all on its own. How good are the autopsies they are performing with that high number of deaths? How good are cause of death reports on a good day? Not that great.

But, there are a lot of diabetics in the ICU. How well do diabetics fare in the ICU? Not that great on a good day.

But, it is a higher than anticipated number of diabetic deaths. Unless everyone is considered a diabetic these days. In general, they say about 10% of the population. So, this could indicate a higher mortality of diabetics. How diabetic are they? Its interesting.

A large portion of the population have diabetes… and yes, statistically they are the less healthy portion… these numbers do not surprise me or alarm me whatsoever…

It doesn’t mean that diabetes increased their mortality, it means that being in poor health did

A larger portion of the people dying of the flu have diabetes, and heart disease, and kidney failure, and cancer and everything else

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I hate to think what it does when it gets to India. Its there, they say.

Well if we are going to look at specifics like this, check out the study from China of 1600 where diabetes was a 1.59 multiplier. That isn’t that bad at all for most of the population which has a TINY healthy population hospitalized/ICU/death rate (0.2 to 1.4% for 20’s through 50’s or 60’s. In fact, I bet the 22% of those diabetic people would have passed away because they were in the older set regardless of diabetes.

Sorry to be cold but that 22% number doesn’t mean much to me at all. Especially with that low a sample size?

ACE blockers only act on ACE, not on ACE2. So ACE2 is not blocked and won’t prevent a viral infection. Upregulation is indeed a natural consequence. When you block an enzyme, your body will try to circumvent that by upregulating either the same enzyme or another.

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