ACEi and ARBs Do Not Increase Risk of COVID-19 Infection Says European Society of Cardiology

March 18, 2020

Physicians and patients should continue treatment with their usual anti-hypertensive or diabetes management therapy, says the European Society of Cardiology (ESC).  There is no evidence that ACEi or ARBs, drugs which upregulate Angiotensin Converting Enzyme (ACE), increase the risk of contracting COVID-19, the society said in a statement published March 13.

Physicians and patients should continue treatment with their usual anti-hypertensive or diabetes management therapy says the European Society of Cardiology (ESC).  There is no evidence that ACEi or ARBs, drugs which upregulate Angiotensin Converting Enzyme (ACE), increase the risk of contracting COVID-19, the society said in a statement published March 13.

“There is no clinical or scientific evidence to suggest that treatment with ACEi or ARBs should be discontinued because of the Covid-19 infection,” wrote Prof. Giovanni de Simone, on behalf of the ESC.

The statement came as a response to a letter published March 11 in the Lancet titled, “Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?in which the  authors suggested that the Coronavirus binds to target cells through ACE2; therefore, increasing ACE2 would result in an increased risk of Coronavirus infection. Since both ACEi and ARBs upregulate ACE2, and these drugs are commonly prescribed for diabetes and hypertension, the authors propose it could explain the increased rates of infection observed in these patient populations.

“The expression of ACE2 is substantially increased in patients with type 1 or type 2 diabetes, who are treated with ACE inhibitors and angiotensin II type-I receptor blockers (ARBs),” the authors wrote.  “Consequently, the increased expression of ACE2 would facilitate infection with COVID-19. We therefore hypothesize that diabetes and hypertension treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19.”

The ESC statement counters that there is little scientific evidence to warrant those conclusions, and there is evidence from animal studies suggesting the opposite may be true, and they may be protective.

“This speculation about the safety of ACEi or ARB treatment in relation to COVID-19 does not have a sound scientific basis or evidence to support it. Indeed, there is evidence from studies in animals suggesting that these medications might be rather protective against serious lung complications in patients with COVID-19 infection, but to date there is no data in humans.”

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