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Any opinions on ACE2 Inhibitors/ARBs? - Printable Version

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Any opinions on ACE2 Inhibitors/ARBs? - GoodGrief - 07-07-2020

HEy folks, in the early days of coronavirus, there was a helpful thread which motivated me to ask my mother’s doctor to switch her hypertension medication from an ARB (losartan) to a water pill (Hydralazine). Somebody explained that coronavirus enters through the ACE2 receptors and that ACE2 inhibitors and ARB’s increase the number of ACE2 receptors, potentially increasing the risk of catching coronavirus. 

So now, 3 months later, I’m wondering if anybody has an opinion on whether ACE2 inhibitors and/or ARB’s increase or actually decrease the chance of catching coronavirus and whether I should switch my mom back to Losartan (her hypertension seemed to be mildly better with Losartan, but not a brobdingnagian difference). I see that there have been some studies but I’d love to hear your thoughts. Thank you for any thoughts.

RE: Any opinions on ACE2 Inhibitors/ARBs? - oldalum - 07-07-2020

Hydralazine is a vasodilator, not a water pill (diuretic). Maybe you're thinking of hydrochlorothiazide, which is a diuretic?
The various professional societies seem to have concluded for now that there is no evidence that ACE-inhibitors or ARBs increase risk of Covid-19; there are theoretical arguments going both ways. They recommend not switching away from them, mainly because they think some people will end up with poorly controlled blood pressure which definitely is inadvisable. But this does not apply to your mom who has already switched. I'd suggest having her doctor and your mother do whatever they think best for treating her blood pressure (considering factors such as effectiveness, side effects, ease of taking, cost), without Covid-19 entering the calculation.

RE: Any opinions on ACE2 Inhibitors/ARBs? - burger - 07-07-2020

There have been a few studies on ACE inhibitors, and iirc they all found either no effect or a positive (ie better outcomes) in people using ACE inhibitors or ARBs.

Here's one: https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.120.317134

Quote:Among hospitalized patients with COVID-19 and coexisting hypertension, inpatient use of ACEI/ARB was associated with lower risk of all-cause mortality compared with ACEI/ARB nonusers. While study interpretation needs to consider the potential for residual confounders, it is unlikely that in-hospital use of ACEI/ARB was associated with an increased mortality risk.

Here's a preprint with a fairly large sample size: https://www.medrxiv.org/content/10.1101/2020.04.07.20056788v2

Quote:There was no evidence for increased severity of COVID19 disease in hospitalised patients on chronic treatment with ACEi or ARB. A trend towards a beneficial effect of ACEi/ARB requires further evaluation in larger meta-analyses and randomised clinical trials.

There are others if you want to hunt around on pubmed or google scholar.

RE: Any opinions on ACE2 Inhibitors/ARBs? - akiddoc - 07-08-2020

If there is any effect, positive or negative, it seems too small to detect.

https://jamanetwork.com/journals/jama/fullarticle/2767669

RE: Any opinions on ACE2 Inhibitors/ARBs? - GoodGrief - 07-08-2020

Thank you so much everybody, I’ll raise the issue with my mom’s gerontologist and let her decide. Thanks again

RE: Any opinions on ACE2 Inhibitors/ARBs? - eyang1990 - 07-09-2020

(07-07-2020, 09:33 AM)GoodGrief Wrote:  HEy folks, in the early days of coronavirus, there was a helpful thread which motivated me to ask my mother’s doctor to switch her hypertension medication from an ARB (losartan) to a water pill (Hydralazine). Somebody explained that coronavirus enters through the ACE2 receptors and that ACE2 inhibitors and ARB’s increase the number of ACE2 receptors, potentially increasing the risk of catching coronavirus. 



So now, 3 months later, I’m wondering if anybody has an opinion on whether ACE2 inhibitors and/or ARB’s increase or actually decrease the chance of catching coronavirus and whether I should switch my mom back to Losartan (her hypertension seemed to be mildly better with Losartan, but not a of immense proportions difference). I see that there have been some studies but I’d love to hear your thoughts. Thank you for any thoughts.

I am a first time poster but long time viewer.  I felt it necessary to respond to this post.  As a cardiologist, we have witnessed many patients concerned about using these types of medications in light of COVID-19.  I can tell you that we don't have any data that indicates increased risk of these medications in COVID-19 patients.  In fact, there are some signals suggested possible benefits, but we will have to await the results of randomized clinical trials.  In general, ACE inhibitors and ARBS should not be discontinued for appropriate clinical indications.  I actually used your post in a presentation I did today on this topic (I hope you don't mind).  I hope this is helpful to the Stanford community.

Here is a link to the video: https://www.acc.org/latest-in-cardiology/features/accs-coronavirus-disease-2019-covid-19-hub/covid-19-education-and-learning/quick-tips-for-fast-thinking

Here is a good resource for patients and interested parties published on our cardiology website with up to date information:
https://www.acc.org/latest-in-cardiology/articles/2020/04/29/12/42/key-questions-faq-on-covid-19-coronavirus-disease-2019-and-cardiovascular-disease



 

RE: Any opinions on ACE2 Inhibitors/ARBs? - dabigv13 - 07-09-2020

Welcome and thanks for your knowledgeable post!

RE: Any opinions on ACE2 Inhibitors/ARBs? - oldalum - 07-09-2020

Yeah, don't be a stranger!

RE: Any opinions on ACE2 Inhibitors/ARBs? - GoodGrief - 07-10-2020

(07-09-2020, 01:12 PM)eyang1990 Wrote:  I am a first time poster but long time viewer.  I felt it necessary to respond to this post.  As a cardiologist, we have witnessed many patients concerned about using these types of medications in light of COVID-19.  I can tell you that we don't have any data that indicates increased risk of these medications in COVID-19 patients.  In fact, there are some signals suggested possible benefits, but we will have to await the results of randomized clinical trials.  In general, ACE inhibitors and ARBS should not be discontinued for appropriate clinical indications.  I actually used your post in a presentation I did today on this topic (I hope you don't mind).  I hope this is helpful to the Stanford community.

Here is a link to the video: https://www.acc.org/latest-in-cardiology/features/accs-coronavirus-disease-2019-covid-19-hub/covid-19-education-and-learning/quick-tips-for-fast-thinking

Here is a good resource for patients and interested parties published on our cardiology website with up to date information:
https://www.acc.org/latest-in-cardiology/articles/2020/04/29/12/42/key-questions-faq-on-covid-19-coronavirus-disease-2019-and-cardiovascular-disease

Haha, of course I don't mind, and thank you for your perspective. I'm tickled that your slide included that all-famous Cardboard phrase, "of immense proportions." I haven't watched your presentation yet, but I look forward to at some point, and I'm sure that your reference to my post was something like, "Here's GoodGrief's post--he must undoubtedly be the smartest and handsomest poster of our generation."

RE: Any opinions on ACE2 Inhibitors/ARBs? - eyang1990 - 08-03-2020

(07-10-2020, 02:19 PM)GoodGrief Wrote:  
(07-09-2020, 01:12 PM)eyang1990 Wrote:  I am a first time poster but long time viewer.  I felt it necessary to respond to this post.  As a cardiologist, we have witnessed many patients concerned about using these types of medications in light of COVID-19.  I can tell you that we don't have any data that indicates increased risk of these medications in COVID-19 patients.  In fact, there are some signals suggested possible benefits, but we will have to await the results of randomized clinical trials.  In general, ACE inhibitors and ARBS should not be discontinued for appropriate clinical indications.  I actually used your post in a presentation I did today on this topic (I hope you don't mind).  I hope this is helpful to the Stanford community.

Here is a link to the video: https://www.acc.org/latest-in-cardiology/features/accs-coronavirus-disease-2019-covid-19-hub/covid-19-education-and-learning/quick-tips-for-fast-thinking

Here is a good resource for patients and interested parties published on our cardiology website with up to date information:
https://www.acc.org/latest-in-cardiology/articles/2020/04/29/12/42/key-questions-faq-on-covid-19-coronavirus-disease-2019-and-cardiovascular-disease

Haha, of course I don't mind, and thank you for your perspective. I'm tickled that your slide included that all-famous Cardboard phrase, "of immense proportions." I haven't watched your presentation yet, but I look forward to at some point, and I'm sure that your reference to my post was something like, "Here's GoodGrief's post--he must undoubtedly be the smartest and handsomest poster of our generation."

GoodGrief.  I definitely used that line in my talk.  Here is a review article I recently published for the European Heart Journal about ACEi/ARBs and COVID-19: https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehaa551/5871935