Study: Patients With COVID-19 Should Continue Treatment With ACE Inhibitors, ARBs

Results of a recent study presented at the American Heart Association (AHA)’s Scientific Sessions 2020 confirmed that patients already taking angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) should not discontinue taking them due to coronavirus disease 2019 (COVID-19) infection.

During the COVID-19 pandemic, there has been speculation regarding the use of ACE inhibitors and ARBs in patients with COVID-19, due to concerns regarding whether these medications may increase the risk of contracting COVID-19.

In order to investigate these concerns, researchers analyzed studies that detailed patients treated with ACE inhibitors and/or ARB medications in the MEDLINE and EMBASE databases. They then conducted 2 meta-analyses to evaluate the results of 17 trials. The first meta-analysis investigated the rate of COVID-19 positive cases, whereas the second meta-analysis determined the mortality rate among hospitalized patients with COVID-19.

The results of the meta-analyses demonstrated that patients taking ACE inhibitors or ARBs did not have an increased rate of COVID-19 infection. Additionally, hospitalized patients with COVID-19 who were taking ACE inhibitors or ARBs were not shown to have an increased mortality rate.

The researchers also conducted a sub-analysis that focused on the data from hospitalized patients with COVID-19 who were treated for hypertension. Among these patients, taking ACE inhibitors and ARBs was associated with a lower mortality rate.

"Our study results confirm that patients already taking ACE inhibitors and ARBs should not discontinue taking them due to COVID-19 infection," said lead study author Yujiro Yokoyama, MD, a surgeon at St. Luke's University Health Network's Easton Hospital, in a press release. "Both medications have proven benefits for heart and kidney disease, and this further confirms previous findings that ACE inhibitors do not pose additional risk with COVID-19."

The researchers also noted that patients with cardiovascular disease who are diagnosed with COVID-19 should be evaluated before any decision is made regarding the addition or removal of treatments. They explained further that any changes to patients’ treatment should be made based on the latest scientific evidence and following discussion with the patients’ physician and health care team.

The results from this study also align with a joint statement issued by the AHA, Heart Failure Society of America, and the American College of Cardiology at the beginning of the pandemic that was designed to address concerns regarding the use of ACE inhibitors and ARBs among patients at risk of COVID-19. In this statement, the organizations made recommendations regarding the continuation of ACE inhibitors or ARBs in patients who are already taking them for indications such as heart failure, hypertension, or ischemic heart disease.

REFERENCE

COVID-19 risks: Irregular heartbeat may increase risk, blood pressure medicines do not. Dallas, TX: American Heart Association; November 9, 2020. eurekalert.org/pub_releases/2020-11/aha-cri110220.php. Accessed November 17, 2020.