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Two papers on ACE inhibitors/ARBs and Covid - Printable Version

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Two papers on ACE inhibitors/ARBs and Covid - BostonCard - 03-30-2020

Neither have a lot of data, and they amount to speculation

New England Journal:
https://www.nejm.org/doi/full/10.1056/NEJMsr2005760?query=RP

Quote:Key Points Related to the Interplay between Covid-19 and the Renin–Angiotensin–Aldosterone System
  • • ACE2, an enzyme that physiologically counters RAAS activation, is the functional receptor to SARS-CoV-2, the virus responsible for the Covid-19 pandemic
  • • Select preclinical studies have suggested that RAAS inhibitors may increase ACE2 expression, raising concerns regarding their safety in patients with Covid-19
  • • Insufficient data are available to determine whether these observations readily translate to humans, and no studies have evaluated the effects of RAAS inhibitors in Covid-19
  • • Clinical trials are under way to test the safety and efficacy of RAAS modulators, including recombinant human ACE2 and the ARB losartan in Covid-19
  • • Abrupt withdrawal of RAAS inhibitors in high-risk patients, including those who have heart failure or have had myocardial infarction, may result in clinical instability and adverse health outcomes
  • • Until further data are available, we think that RAAS inhibitors should be continued in patients in otherwise stable condition who are at risk for, being evaluated for, or with Covid-19


Note they put forward a theoretical benefit to ACE inhibitors/ARBs.

And from JAMA:
https://jamanetwork.com/journals/jama/fullarticle/2763803?guestAccessKey=c6e4f543-7a1a-449d-8b42-efa481eacd2c&utm_content=weekly_highlights&utm_term=032820&utm_source=silverchair&utm_campaign=jama_network&cmp=1&utm_medium=email

With quotes from the relevant expert societies:

Quote:In response, the Council on Hypertension of the European Society of Cardiology made the following statement, “The Council on Hypertension strongly recommends that physicians and patients should continue treatment with their usual anti-hypertensive therapy because there is no clinical or scientific evidence to suggest that treatment with ACEIs or ARBs should be discontinued because of the COVID-19 infection.”8 This statement has been followed by similar statements from a number of different societies suggesting patients continue their current hypertensive medication regimen. On March 17, 2020, the American Heart Association, the Heart Failure Society of America, and the American College of Cardiology put out a joint statement advocating for patients to continue ACEIs and ARBs as prescribed and that changes in medications in the setting of COVID-19 should be completed only after careful assessment.9

BC