March 13, 2020

expert reaction to questions about high blood pressure, diabetes, and ACE inhibitor drugs, and risk of COVID-19 infection

Response to journalists’ questions bout high blood pressure, diabetes, and ACE inhibitor drugs, and risk of COVID-19 infection.

Prof Tim Chico, Professor of Cardiovascular Medicine and Honorary Consultant Cardiologist, University of Sheffield, said:

“This letter does not report the results of a study; it simply raises a possible question about whether a type of blood pressure and heart disease medication called ACE inhibitors might increase the chances of severe COVID19 infections.  It does not give any evidence that confirms this, simply that it suggests such a relationship should be looked for.

“It is very important that this letter is not interpreted or reported as saying that ACE inhibitors are proven to worsen COVID19 disease.  With more information we will begin to be able to understand whether the relationships between disease severity and existing disease and treatment.

“I strongly advise anyone on heart medications not to stop or change these without discussion with their doctor.  If a patient stops their medication and worsens to the point of requiring admission to hospital at the same time as we are dealing with an increase in COVID19 cases, that would pose the patient a considerable risk and put further strain on the healthcare services.”

Prof Peter Sever, Professor of Clinical Pharmacology & Therapeutics, Imperial College London, said:

“There are some questions about whether certain drugs such as angiotensin converting enzyme inhibitors and angiotensin receptor blockers, commonly taken by patients with hypertension, heart failure and diabetes might increase susceptibility to corona virus infection.  On the other hand these drugs could reduce the risk of serious lung disease following infection.

“At the present time we have no evidence as to whether either of these two possibilities are true.

“Patients could be put at risk by stopping these drugs, which are effective treatments for their current condition, without medical supervision, and until further evidence is available should be encouraged to continue their current treatment.”

Prof Hugh Montgomery, UCL Professor of Intensive Care Medicine, UCL, said:

“There is no proof yet that the use of ACE inhibitors worsen Coronovirus infection.  There are theoretical reasons, in fact, why they might offer benefit in serious disease.  I would not advocate people ceasing such medication until the evidence has been weighed and clear guidance issued.”

Dr Dipender Gill, Specialist Registrar in Clinical Pharmacology and Therapeutics at Imperial College Healthcare NHS Trust, and a Postdoctoral Researcher at Imperial College London, said:

“Evidence is currently lacking and it is too early to make robust conclusions on any link between use of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II type-I receptor blockers with risk or severity of novel coronavirus disease 2019 (COVID-19) infection.  Furthermore, the acute implications of stopping such medications in relation to effects on risk or severity of COVID-19 infection are not known.  Patients should be advised to follow public health guidance rather than alter their medications without proper and informed consultation with their medical doctor.”

* https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(20)30116-8.pdf

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