On the Cardboard, we've discussed these two letters that suggest investigating whether any correlation exists between using ACE inhibitors (ACEI, including drugs that typically end in "pril") or ARB drugs (typically ending in "artan")
COVID-19 and the cardiovascular system
Re: Preventing a covid-19 pandemic: ACE inhibitors as a potential risk factor for fatal Covid-19
As I understand these, they point out theoretical reasons there might be a relation between COVID-19 infection/outcomes and ACEI and ARB usage. Neither had any supporting data that I noticed.
[added 3/15] The Council on Hypertension of the European Society of Cardiology highlights the lack of any evidence supporting harmful effect of ACE-I and ARB in the context of the pandemic COVID-19 outbreak. The Council on Hypertension strongly recommend that physicians and patients should continue treatment with their usual anti-hypertensive therapy...
ACE inhibitors and ARBs are often prescribed to reduce hypertension. ARBs are used for diabetic patients.
For the TL;DR crowd![[Image: blinking12.gif]](http://www.steveradick.com/wp-content/uploads/2010/10/blinking12.gif)
Of the 4 hardest hit countries, the highest CFR corresponds to high use of ACE Inhibitors; the lowest CFR corresponds to lowest use of ACE Inhibitors. No obvious correlation for ARB. Small sample, weak data, unreviewed
I expect that any of the 4 worst-hit countries could supply data as to outcomes of patients that take particular medications. I might speculate the fact that this hasn't been done might indicate that there is no correlation.
Since we don't have that information, I looked for whatever information I had access to. I took the 4 worst-hit countries and looked at published information for their drugs of choice for hypertension.
Here, CFR (case fatality rate) indicates deaths/confirmed cases including active cases (ie, an underestimate of CFR). Data from WHO sitrep for 13-Mar.
For Iran, the only data I found was for a sample (n=300) from a few villages in one region. Apparently Iran has had a recent push to get hypertension patients registered in an online database. That data may be available but I didn't see it.
Please remember that this is not medical advice. Talk to your doctor to determine what is best for you. I am not a physician, nor a medical researcher, nor a statistician. This data has not been reviewed or validated by anyone in that field. There may be errors (let me know!).
The numbers in the ACEI column indicates the percentage of hypertension drug usage in that country that are ACE Inhibitors. The numbers in the ARB column indicate the percentage for ARBs for that purpose. If the source indicated a combination of drugs are used, then if one of them is either of these classes, then I added it in.
[added 3/15] The demographics of each country is different. Since the death rate appears to be sensitive to age, I have added a column to try to help account for the demographics.
The "CFR%/65+%" column is the ratio of the CFR and the country's 65+ population. If the CFR were 5% and 10% of the population was 65+, then that column would show 50%.
ACE Inhibitor & ARB usage:
China:
2017 data for hypertension prescriptions in China indicates 9% of hypertension prescriptions are for ACEI and 21.7% for ARB, 9.3% Beta blockers, 45.7% for calcium channel blockers, 4.5% diuretics, 5.1% traditional compound, 4.7% fixed dose compound, 0.35 centrally active drugs.
In Italy, ACEI has the highest use.
2016 study: (initial treatment) ACEI 38.1%, beta blocker alone 14.2%, ARB alone 32.8%, ACEI+diuretic 11.4%, calcium channel blocker alone 10.0%, fixed dose ARB+diuretic 6.0%,
In Iran, I didn't find data on drugs used generally. Here are Iranian recommendations regarding hypertension.
I did find this article giving hypertension drug use in some villages in one small region(n=300): 60% beta blockers, 25% calcium channel blocker, 6% ACEI, 4% ARB, 5% diuretic.
2002 study.
A 2019 news article indicated about 22% have hypertension. Of those, only 60% are aware of it. Of those, only half receive medication. Another article..
Korea: ARB became the most widely used drug in 2016 (43.3%), calcium channel blockers (42.8%). Beta blockers 7.3%, diuretics 4.3%, ACEI 1.9% Others 0.3%
(40% prescribed 1 class of meds, 42% 2 classes, 18% 3+ classes)
COVID-19 and the cardiovascular system
Re: Preventing a covid-19 pandemic: ACE inhibitors as a potential risk factor for fatal Covid-19
As I understand these, they point out theoretical reasons there might be a relation between COVID-19 infection/outcomes and ACEI and ARB usage. Neither had any supporting data that I noticed.
[added 3/15] The Council on Hypertension of the European Society of Cardiology highlights the lack of any evidence supporting harmful effect of ACE-I and ARB in the context of the pandemic COVID-19 outbreak. The Council on Hypertension strongly recommend that physicians and patients should continue treatment with their usual anti-hypertensive therapy...
ACE inhibitors and ARBs are often prescribed to reduce hypertension. ARBs are used for diabetic patients.
For the TL;DR crowd
Of the 4 hardest hit countries, the highest CFR corresponds to high use of ACE Inhibitors; the lowest CFR corresponds to lowest use of ACE Inhibitors. No obvious correlation for ARB. Small sample, weak data, unreviewedI expect that any of the 4 worst-hit countries could supply data as to outcomes of patients that take particular medications. I might speculate the fact that this hasn't been done might indicate that there is no correlation.
Since we don't have that information, I looked for whatever information I had access to. I took the 4 worst-hit countries and looked at published information for their drugs of choice for hypertension.
Here, CFR (case fatality rate) indicates deaths/confirmed cases including active cases (ie, an underestimate of CFR). Data from WHO sitrep for 13-Mar.
For Iran, the only data I found was for a sample (n=300) from a few villages in one region. Apparently Iran has had a recent push to get hypertension patients registered in an online database. That data may be available but I didn't see it.
Please remember that this is not medical advice. Talk to your doctor to determine what is best for you. I am not a physician, nor a medical researcher, nor a statistician. This data has not been reviewed or validated by anyone in that field. There may be errors (let me know!).
The numbers in the ACEI column indicates the percentage of hypertension drug usage in that country that are ACE Inhibitors. The numbers in the ARB column indicate the percentage for ARBs for that purpose. If the source indicated a combination of drugs are used, then if one of them is either of these classes, then I added it in.
| Country | Cases 13-Mar | CFR 13-Mar | 65+ | CFR%/65+% | ACEI | ARB |
|---|---|---|---|---|---|---|
| China | 80991 | 3.9% | 11.3% | 34.5% | 9.0% | 21.7% |
| Italy | 15113 | 6.7% | 22.3% | 30.0% | 49.5% | 38.8% |
| Iran | 10075 | 4.3% | 6.0% | 71.7% | (6%) | (4%) |
| Korea | 7979 | 0.8% | 15.9% | 5.0% | 1.9% | 43.3% |
[added 3/15] The demographics of each country is different. Since the death rate appears to be sensitive to age, I have added a column to try to help account for the demographics.
The "CFR%/65+%" column is the ratio of the CFR and the country's 65+ population. If the CFR were 5% and 10% of the population was 65+, then that column would show 50%.
ACE Inhibitor & ARB usage:
China:
2017 data for hypertension prescriptions in China indicates 9% of hypertension prescriptions are for ACEI and 21.7% for ARB, 9.3% Beta blockers, 45.7% for calcium channel blockers, 4.5% diuretics, 5.1% traditional compound, 4.7% fixed dose compound, 0.35 centrally active drugs.
In Italy, ACEI has the highest use.
2016 study: (initial treatment) ACEI 38.1%, beta blocker alone 14.2%, ARB alone 32.8%, ACEI+diuretic 11.4%, calcium channel blocker alone 10.0%, fixed dose ARB+diuretic 6.0%,
In Iran, I didn't find data on drugs used generally. Here are Iranian recommendations regarding hypertension.
I did find this article giving hypertension drug use in some villages in one small region(n=300): 60% beta blockers, 25% calcium channel blocker, 6% ACEI, 4% ARB, 5% diuretic.
2002 study.
A 2019 news article indicated about 22% have hypertension. Of those, only 60% are aware of it. Of those, only half receive medication. Another article..
Korea: ARB became the most widely used drug in 2016 (43.3%), calcium channel blockers (42.8%). Beta blockers 7.3%, diuretics 4.3%, ACEI 1.9% Others 0.3%
(40% prescribed 1 class of meds, 42% 2 classes, 18% 3+ classes)