COVID-19: Should I Avoid Blood Pressure-Lowering Medicines?

Based on the mechanism in which the virus enters the cell, some doctors have postulated that taking certain groups of medicines, such as angiotensin-converting enzyme (ACE) inhibitor and angiotensin receptor blockers (ARB) may increase the risk of being infected by the SARS-CoV-2. These two groups of medicines are commonly used to treat patients with hypertension, heart failure and narrowing of coronary arteries.

The common drugs are enalapril, lisinopril and perindopril for ACE inhibitors and candesartan, irbesartan, losartan, olmesartan, telmisartan and valsartan for ARB. Administration of these medicines increases an enzyme, known as angiotensin converting enzyme-2 (ACE2), which helps to produce anti-inflammatory substances and protect the blood vessel lining. These actions are favourable for patients with hypertension and heart disease. But this enzyme, which is on the cell surface, is also the protein on which SARS-CoV-2 attaches in order to enter the cell.

These potential adverse pathways, however, are not applicable to humans. There are also clinical studies which suggest that administration of this group of medicine or even infusion the angiotensin converting enzyme-2 alone or together with a specific type of white blood cell , may benefit patients with severe pneumonia.

Considering the potential benefits of these two groups of medicines, several professional societies and colleges do not recommend the routine withdrawal of these drugs to reduce the chance of succumbing to COVID-19 or lower the severity of the infection. The basis for this recommendation is that the potential risk of discontinuing such medicines may cause the chronic condition to worsen. Currently, there are several clinical trials to determine if it is beneficial or not to change ACE inhibitor or ARB to another blood pressure-lowering medicine .

On the other hand, initiating treatment with ACE inhibitors for a patient with high blood pressure or heart failure may pose another challenge. Although less common among Caucasians, cough or itchy throat are common adverse effects, which may be confused with COVID-19 symptoms. Cough and itchy throat occur less frequently among patients treated with ARB.

Bearing these issues in mind, please discuss with your doctor as to whether you should continue with the medicine or change to another pharmacological agent.