ACE Inhibitors, ARBs Can Be Safely Used For Hypertension In COVID-19, Study Confirms

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) can be safely used in COVID-19-infected patients with hypertension, according to a retrospective study from China.

"COVID-19 patients on these drugs have no reason to discontinue them, as suggested by the European and American Societies of Cardiology," Dr. Yafei Huang of Tongji Medical College, Huazhong University of Science and Technology, in Wuhan, told Reuters Health by email.

SARS-CoV-2, the coronavirus that causes COVID-19, uses ACE2 to enter host cells, which early in the pandemic raised concerns that ACE inhibitors and ARBs might facilitate infection with the virus. Recent studies have suggested that this is not the case.

Because comorbidity with hypertension is common in patients infected with SARS-CoV-2, Dr. Huang and colleagues assessed the effects of ACE inhibitors and ARBs on SARS-CoV-2 infection, inflammatory status and clinical outcomes in COVID-19 patients.

Their retrospective study included 126 patients with pre-existing hypertension and 125 age- and sex-matched patients without hypertension. Among the patients with hypertension, 43 had been treated with ACE inhibitors or ARBs.

The frequency of ACE inhibitor/ARB use in these COVID-19 patients was similar to that in hypertension patients admitted to the hospital before COVID-19 emerged, the authors report in Hypertension.

Compared with the hypertension group, the non-hypertension group had fewer cases of critical illness (11.2% vs 18.3%) and fewer deaths (6.4% vs 10.3%), but these overall differences were not statistically significant.

Within the hypertension group, patients on ACE inhibitors/ARBs had fewer cases of critical illness (9.3% vs 22.9%) and a lower death rate (4.7% vs 13.3%), but these differences also fell short of statistical significance.

COVID-19 patients with pre-existing hypertension had lower arterial partial pressure of oxygen; higher blood urea, ALT, and cardiac troponin; and higher concentrations of high-sensitivity C-reactive protein (hsCRP), procalcitonin and IL-6.

Within the hypertension group, however, patients receiving ACE inhibitors/ARBs had significantly lower concentrations of hs-CRP and procalcitonin, compared with patients not receiving these drugs.

"Prospective randomized investigations are needed to confirm what we found in this single-center retrospective one," Dr. Huang said.

—Will Boggs MD

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