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

COVID-19
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This morning, I was wondering WHY WHY WHY in thinking about Spain and Italy. I watched an extended piece on the Al Jazeera station/web site. The moments of silence in Italy are heartbreaking.

Italians and Spanish are among the world’s biggest talkers - interrupting their interruptions. Hard to get a word in edgewise in those spectacular cultures. I don’t know if their propensity for affection, touching, warmth and nonstop talking have anything to do with the tragedies in their countries, but I thought it may be a big contributor. Talking produces droplets and aerosolized droplets.

Italians are mightily struggling with the current social isolation. Having traveled with an Italian while in Spain, when he would get homesick it was like a coming storm hung over our group, he was so palpably sad.

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This offers a decision tree on continuing or stopping ACE/ARB’s:

Drugs and the renin-angiotensin system in covid-19

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More suggestions, although I would check with one’s doctor before doing anything…

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This 3 April 2020 YouTube video interview by Ivor Cummins of Nadir Ali, cardiologist, about ACE inhibitor and ARB meds examines how these common hypertension drugs might interact with COVID-19. This conversation is unique in all the coverage I’ve followed in that it talks about the option of using lifestyle choices as an alternative to only considering pharmaceuticals to control high blood pressure.

Dr. Ali carefully measures his words and makes sure to recognize that this is not a settled issue but one that requires more scientific inquiry. He does not make any hard and fast recommendations. I think it’s worth investing some of your time to watch this.

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As it relates to elevated levels of ACE2:

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@JamesIgoe – As a former smoker, I’m reassured by this observation from the cited study.

“We also found that former smokers had similar levels of ACE-2 to people who had never smoked. This suggests that there has never been a better time to quit smoking to protect yourself from COVID-19.”

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Same here, smoked from 12 to 29, with 1.5 years when I was able to quit. Haven’t touched it for 30 years…

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More on ACE2:

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Reading all this I wonder what you think of this: Take calcium channel blocker to prevent the virus and then if you think you have it switch to ARB for its anti-inflammetory action.

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:man_facepalming:
I’m not sure we should be self-medicating in this way.

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I don’t think that doctors will be available if things get worst which is to be expected. I have both medications and can switch. Endo is supposed to call me next Tuesday so I will ask him if he has heard anything about this ?

What about the Minnesota study any results ?

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Doctors are nothing but available! Look, the only medical staff who are really busy these days are in the ED and ICU, everyone else has become a computer jockey. It’s ridiculous. These PCPs are precisely the ones who need to be contributing more by reading the research, digesting the research, having Zoom meetings with other researchers and docs, then DISPENSING KNOWLEDGE TO PATIENTS. That everyone has retreated behind their laptops is …

Do you see that hot red flame? That’s me and my blood pressure sky-rocketing just thinking about this! Pass the ARBs!

Ha ha. But seriously, doctors are available and they are losing money, so they need and want to see patients. Schedule a telehealth visit.

Do not self-medicate with BP meds, people!!!

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I don’t disagree with your sentiment here, but you may not appreciate the experience of long-term insulin dosing diabetics. Some of us, for decades, have made insulin dosage changes with a medication that when misdosed can cause serious problems, including death. I learned many years ago that clinicians are not an ideal source of insulin dosing advice. They are impaired with an inordinate fear of hypoglycemia, so they simply err well on the side of hyperglycemia.

Now I know there are excellent exceptions to my experience and it’s great for those patients who enjoy a great doctor.

I get your natural caution about making med changes without the supervision of a doctor, but many of us have lived with less than stellar support in dosing our insulin. I haven’t take any granular insulin dosing advice from my doctor in well over 30 years. They just don’t know me well enough and are not competent (for me) beyond making general remarks and observations.

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I work with diabetic patients, so I’m not sure why you’d say I don’t appreciate their/your experience. I was not talking about insulin, but BP meds which are a different proposition. I do appreciate the perspective of people who daily dose with insulin, especially on this board. [scratches head]

I was talking about BP meds, you are talking about insulin.

What am I missing?

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The experience of someone who lives with diabetes is materially different from someone professionally engaged in their treatment. I live with diabetes 8760 hours per year and a practitioner may spend 2000 professional hours per year with a wide diabetic patient base. I’m a specialist and you’re a generalist. I have skin in the game, you don’t.

I realize it is not directly equivalent experience but it does grant the patient a considerable amount of experience that I suspect most practitioners don’t fully appreciate. We patients do not have a credential we can point to but our personal insulin dosing experience dwarfs that of clinicians.

What you’re missing is that the mindset created by making continuous daily insulin adjustments without the close supervision of a doctor can affect the mindset for other drugs like blood pressure meds, a common med that many people with diabetes take.

I am not condoning this practice, just trying to shed some light on why someone like @Anthony_Holko might be tempted to make a unilateral med change.

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think i’m gonna bow out of this thread, with respect.

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I have to agree with @The_Senator_From_Glu here. While people’s mindset may be changed by their experience with insulin dosing, they have to realize that the skills acquired by insulin dosing don’t translate to dosing of other medication. This isn’t a generic skill. Other drugs are totally different, so people should resist the temptation to make medication changes without consulting their doctor.

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One of the most important aspects of maintaining one’s health is staying informed, particularly as a Type 1. Doctors might have the prescribing pad, but their recommendations need to be considered, to make sure they make sense. Doctors are often manipulated by the pharmaceutical and device industries, and their knowledge can become stale over time, so it pays to evaluate treatment suggestions independently, and then discuss it with the practitioner.

Some doctors can be outright ignorant or ill-informed, so one needs to self-educate, to understand the difference between medications and practices. Also, one needs to be self-motivated, as the attitude of the doctor impacts care. Some are somewhat laissez-faire, leaving most care up to the patient, acting as a taker of tests and recorder of complaints, but not much more.

I was told by one one my previous doctors that I was the 1% of his patients, he meant that in terms of knowledge rather than control. We would spend a long time talking late on Fridays, before he sold his practice to the hospital, because he found me useful and/or insightful. I equally found our discussions useful, as he was very good at suggesting insulin dosing changes and discussing lifestyle. Contrast that with other practices where I’ve had to direct them to make changes in my regimen, to change my anti-hypertensive medication, down when I experienced orthostatic hypotension, or higher when I gained weight. Even my recent foray into CGM’s was driven by a slip in my control, affected by my new doctor’s practice.

Granted, doctors have the prescribing pad, and are typically much more knowledgeable than patients, but they are not all-knowing and infallible. In fact, its quite the opposite, so I think it pays to raise this question with one’s consultant, to see if they think an ARB might be better than and ACE-inhibitor, or even a calcium channel blocker, particularly if an ARB might be better in this instance. Talking with them is inexpensive, and not talking could mean the difference between life and death.

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I’m sorry my words forced you out of the conversation. I should have been less personal; please accept my apology. Your intentions are moral and I should respect that.

Off topic, but this may help a health care practitioner like yourself gain some insight into the perspective of patients like me. When I look back over my long time struggling with T1D, I can see many opportunities for my doctors to markedly improve my diabetes health but they did not.

For example, limiting carbs in my diet proved to be a drastic improvement in my glucose control and many other health markers like body weight. The fact that the professional associations demonized limiting carbs and professionally ostracized low-carb proponents (and T1D!) like Dr. Richard Bernstein made me realize that doctors do not have all the answers. In fact, a well-informed patient can employ many health tactics with surprising success.

For me, I consider the omission of sound and effective diabetic dietary advice from doctors and other health care providers borders on malpractice. Doctors almost universally dismiss this criticism and observe that they only received an hour or two of nutrition facts during their medical school curriculum. That may explain it but it doesn’t excuse it.

But you are not responsible for the past actions of your profession. I suspect you participate here to gain insight from people like me; I appreciate that. I’ll try to be more considerate going forward!

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Politics apart has anyone heard of the U of Minnesota results on Lorsartan ?