Blood pressure lowering drugs found to be safe for coronavirus patients after initial concern

Capsules left lying on table, with open pill bottle
Concerns were initially raised two classes of blood pressure lowering drugs may increase the coronavirus’ ability to bind to human cells. (Stock, Getty Images)

Drugs that are commonly prescribed to lower blood pressure do not affect the outcome of patients hospitalised with the coronavirus, research suggests.

Early in the pandemic, some studies suggested medications known as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-2 receptor blockers (ARBs) may increase the ability of the virus’ receptors to bind to human cells, aiding its entry into the body and subsequent replication.

Research later suggested there is no link between the use of these drugs and severe coronavirus complications, however, scientists from the University of Pennsylvania felt high-quality results were lacking.

To learn more, a team analysed 152 people from several countries who were taking ACEIs or ARBs prior to being hospitalised with the coronavirus.

Results suggest the patients who stopped taking these drugs while in hospital had comparable outcomes to those who continued with the medication.

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Amid the pandemic, the NHS has stressed people should take their blood pressure treatment as prescribed, stressing there is “no clear evidence taking ACE inhibitors or ARBs will cause complications”.

The Pennsylvania scientists added “we have high-quality evidence to support our recommendation that patients continue to take these medications as prescribed”.

Doctor checking the blood pressure of a patient
Around a third of adults in the UK have high blood pressure, often measured via an arm cuff. (Stock, Getty Images)

“At the start of the pandemic, patients were worried about perceived harm based on limited and incomplete information, and unfortunately, some insisted on stopping their medications,” said study author Dr Jordana Cohen.

“However, stopping these medications unnecessarily can increase the risk for severe complications, including heart attack and stroke.

“Now we have high-quality evidence to support our recommendation that patients continue to take these medications as prescribed.”

Around a third of adults in the UK have high blood pressure, many of whom are undiagnosed.

In the US, more than 49 million adults take medication to lower their blood pressure, of whom around 41 million (83%) are on an ACEI or ARB.

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ACEIs – such as enalapril, lisinopril, perindopril and ramipril – work by relaxing blood vessels, however, some patients endure side effects like a persistent dry cough, headaches, dizziness and rashes.

If the adverse events are intolerable, doctors may prescribe ARBs, which work in a similar way. Examples include candesartan, irbesartan, losartan, valsartan and olmesartan.

Following concerns the drugs could worsen coronavirus complications, the Pennsylvania scientists investigated the treatments as part of the REPLACE COVID trial.

“Observational studies were rapidly done, but randomised trials are important to establish a definitive answer regarding the potential impact of these commonly used blood pressure medications in the setting of COVID-19 [the disease caused by the coronavirus],” said co-author Dr Julio Chirinos.

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The 152 participants were enrolled on to the trial between 31 March and 20 August.

They were randomly assigned to either stop or continue taking their blood pressure drugs, with medics monitoring them closely for any adverse events.

A “global rank score” was created to classify the patients’ outcomes.

This was based on the time between hospitalisation and death, as well as the time the patient spent on mechanical ventilation or extracorporeal membrane oxygenation – equipment that pumps oxygenated blood around the body.

The assessment also took into account the length of time a patient spent on renal replacement therapy – like dialysis, as well as a modified sequential organ failure assessment score – a measure of organ function that predicts a critically-ill patient’s death risk.

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Results, published in the journal The Lancet Respiratory Medicine, suggest there was no difference in the global rank scores of the patients who stopped their blood pressure drugs and those who continued to take them while in hospital.

“Our trial results importantly show these medications can be safely continued for patients hospitalised with COVID-19,” said Dr Chirinos.

Studies are investigating if these blood pressure drugs may even boost a coronavirus patient’s outcomes, with some research showing reason for optimism.

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