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COVID-19: Heart and kidney patients should keep taking their medicines

Forgoing these medications would increase health risks for millions of patients with hypertension and congestive heart failure.

Jeff Lagasse, Associate Editor

As the COVID-19 coronavirus pandemic unfolds, inaccurate medical information has flooded social media and other channels. One potentially lethal example is that patients who take renin-angiotensin system blockers, particularly angiotensin II type 1 receptor blockers (ARBs), may be more susceptible to the virus.

However, in an article published in the American Heart Association journal Hypertension, Murray Epstein, M.D., emeritus professor of medicine at the University of Miami Miller School of Medicine, and colleagues warn there is little credible or consistent evidence to back up this concern.

Equally important, foregoing these important medications would dramatically increase health risks for hundreds of millions of patients with hypertension, congestive heart failure and chronic kidney disease.

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The one thing that can be concluded definitely at this point: There's no credible evidence that ARBs enhance a person's susceptibility to COVID-19.

WHAT'S THE IMPACT?

In the article, the authors carefully reviewed the available data to determine whether ARBs pose any significant risk.

They said the concern originated from reports that the angiotensin-converting enzyme 2 (ACE 2) protein receptor may enable viral entry into cells. Amplified by various media, this led some patients to discontinue their medications – either on their own or based on advice from a physician.

But the evidence that ARBs may increase COVID-19 risk is spotty at best. Though some studies have shown ARBs increase ACE 2 activity in animal models, it should be emphasized that the results have been inconsistent.

Because of that, many people are making an ill-advised leap of logic. The thinking goes that, if it enhances penetrability, it augments susceptibility to COVID-19. But the results from investigators have varied greatly, and were influenced by the organ studied, the specific animal model and the ARB used in the study. That all adds up to a significant lack of consistency.

While there is no credible evidence that ARBs increase COVID-19 risk, Epstein said there are clear dangers for patients who stop taking their medications. ARBs are prescribed for high blood pressure, congestive heart failure, kidney disease and other conditions. Widespread discontinuation of ARBs and ACE inhibitors could cause destabilization of blood pressure control and decompensation of heart failure patients, leading to sharp increases in heart attacks and strokes and a worsening of kidney failure.

And it would happen right when hospital and intensive care unit resources are already stressed to the max, further taxing medical facilities and hospitals.

THE LARGER TREND

About half of patients treated for mild COVID-19 infection still had coronavirus for up to eight days after symptoms disappeared, research found last week. That's something healthcare workers should keep in mind as they remain on the front lines in treating those afflicted with the rapidly spreading disease.

Patients kept "shedding" the virus for up to eight days even after the resolution of their symptoms, and, since their symptoms were mild, there's reason to believe that those with more severe infections may have the ability to spread the virus for even longer.
 

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com