BOSTON — With so many unanswered questions looming over the novel coronavirus and how it interacts with certain drugs, patients taking high blood pressure medication are unsure on whether to stick to them or to switch over.
Looking back 18 years ago, when researchers found the SARS virus was especially attracted to sites in the lower lung, known as ACE-2 receptors, patients today are wondering what that means for COVID-19. Since both viruses are very similar, “there’s been a lot of speculation about whether COVID-19 enters into the lower respiratory tract and docks to the ACE-2 receptors in the lung,” according to Dr. Greg Lewis, a cardiologist at MGH.
Some high blood pressure drugs known as “ACE inhibitors” as well as a related class known as ARBs can raise levels of ACE-2. However, as Lewis explains, this has only been proven in animal studies, meaning it’s not necessarily true for humans.
“But in humans that has not been a consistent finding, number one, and number two, it’s not even clear whether having more ACE-2 helps you or hurts you,” said Lewis.
In experimental studies, both ACE inhibitors and ARBs have been shown to reduce severe lung injury in certain viral pneumonias. It has also been speculated these agents could be beneficial in fighting COVID-19.
“There’s all this hysteria,” said Lewis. “In fact, cardiologists send me protocols from prominent institutions saying that they’ve have a procedure by which they’re stopping people’s ACE Inhibitors and ARBs and I couldn’t think of a worse thing to do right now.”
The Heart Failure Association of America, the American College of Cardiology and the American Heart Association agree that patients on these medications should not be taken off them simply due to COVID-19 fears, saying:
“(We) recommend the continuation of (these drugs) for patients who are currently prescribed such agents for indications for which these agents are known to be beneficial.”
That being said, the organizations are also calling for “urgent, additional research that can guide us to optimal care.”
Lewis says he’s not necessarily advocating for a wider use of ACE inhibitors and ARBs at this time, but that there is not point in taking patients off medication that has been working.
“Seems to me like we better be pretty sure about what we;re doing before we start advocating those types of practices,” said Lewis.