ACE inhibitors and ARBs. There's a lot of controversy about whether or not people
should be taking and whether they're safe. And there are even some people are
saying actually there may be safer than not taking them. This YouTube video comes
from the program component of the YouTube live program on Friday April 3rd.
It's on the "Blood Pressure Medicines and COVID-19." So again, we're talking
about ACE inhibitors. For those of you who are geeks want to know what that
means or just curious... angiotensin converting enzyme inhibitor. And ARB
means angiotensin receptor blocker. So why are these an issue for COVID-19? You
may remember this came from Med Cram. They were drawing the issue here. ACE2
receptors in the cell membrane are what they spike protein from the coronavirus
latches on to ACE2 receptors, how that virus gets into the cell. So there been
questions and concerns about it. There was an article in The Lancet that talked
about this. We'll talk about that article in Lancet that raised the whole issue.
And then we'll start talking about the responses from groups like the European
Society of Cardiology (ESC), other standards committees, then the New
England Journal weighed in on it and finally the American Heart Association.
So again, what first came up was the ACE2 receptors are used by the virus, and ACE2
receptors may actually be increased if you're using ARBs or ACE inhibitors.
That's ace inhibitors for example often end with "pril," like ramipril,
benazepril, lisinopril the most commonly used one. And the ARBs often end in "tan,"
so like losartan and several of those. Now those medicines have been found to
be very very helpful for high blood pressure, especially that associated with
prediabetes and diabetes. Well, that's a big deal because most
high blood pressure is associated with diabetes and prediabetes. So here's what
started all of this fear and trouble and debate. It was an article by Lei Fang,
George Karakiulakis, and Michael Roth in The Lancet Respiratory Medicine on
March 11th Here's what they said. ACE2 receptors are increased when you
use these receptor blockers, ARB inhibitors These data suggest that ACE2
receptor expression is increased in diabetes and treatment with ACE
inhibitors and ARBs increases ACE2 expression. Consequently, the increased
expression of ACE2 would facilitate infection with COVID-19. We therefore
hypothesize the diabetes and hypertension treatment with ACE2-
stimulating drugs ARBs and ACE inhibitors increase the risk of
developing severe and fatal COVID-19. Well, what can be scarier than that?
Now, the first standards committee that came out in response to this was the
European Society for Cardiology, and the specific group was their Hypertension
Committee the Council on Hypertension. And this was a position statement that
was published... position statement of the ESC Council on Hypertension on ACE
inhibitors and ARBs. The Council on Hypertension strongly recommend that
physicians and patients should continue treatment with their usual
antihypertensive therapy because there is no clinical or scientific evidence to
suggest the treatment with ACE inhibitors or ARBs should be
discontinued because of the COVID-19 infection. And that was Dr. Giovanni de
Simone, the chair of the ESC Council on Hypertension. So they note. Another
article came out just a couple of weeks later, and they mentioned this article.
Also again, Lancet Respiratory Medicine, Antihypertensive Drugs and the Risk of
COVID-19. This was by Christopher Tignanelli and
several others. Here's their quotes. Lei Fang suggests withholding ACE inhibitors
or ARBs because of risk for COVID-19 infection. They also suggested that we
switch to calcium channel blockers. This is a premature hypothesis because
confusion with the media, the public, and the medical community. They did this
despite calls to the opposite from multiple groups including the European
Society of Cardiology, Hypertension Canada, UK Renal Association, and the
International Society for Hypertension. Ao as you may know, you've seen me, I tend
to be very comfortable not following standards committees because I've been
involved with those before and I know how they think. For example, I don't
follow the exact standards committee's recommendations for statins. Now I do
agree with the standards committees on this one, though. I do not recommend
changing. In fact, I personally do take ACE inhibitor, used to take ramipril and
now take benazepril. And I have not stopped taking those. Couple of days
later, the New England Journal weighed in on this. In their article Renin-
Angiotensin-Aldosterone System Inhibitors in Patients with COVID-19.
They said, guidance is needed. Withdrawal from these medications can be dangerous.
And they went so far as to say, we proposed an alternative that ACE2 drug
related drugs may be beneficial. So we recommend you continue medications, and
clinical trials are underway to totally prove this issue out. Well, since then, the
American Heart Association has now issued new guidance. Again, it's
consistent with everybody else, except Lee Fang and his guys. The AHA guidance,
the American Heart Association guidance. They noticed they went back and quoted
some of the original data from Wuhan talking about the increased risk with
diabetes, cardiovascular disease, lung disease, and high
pressure. But they went on to say, do not stop your ACE inhibitors,
your ARBs. However, we do recommend that you watch for other medicines that
commonly are taken and commonly increase blood pressure, for example, NSAIDs
(non-steroidal like Ibuprofen, Motrin), oral contraceptives, alcohol (and pardon me I
misspelled alcohol), caffeine (they said limit it to 3 cups per day), and even
some supplements, and other types of foods like licorice. So there you have it.
There's the facts. So far is totally proven inconclusive now. This is way
too early to be conclusive, but I do agree with the standards committees on
this one. I think it would be premature. And as they've said in the New England
Journal article, I think there's a strong possibility that these may even help
compared to not taking them. So I'm still taking my benazepril until and unless
things start to look very different. Thank you for your interest.
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