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When facts are few and far between, misinformation often steps in to fill the gap. That’s precisely what happened when a prominent British medical journal published an opinion article on March 11 suggesting that angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers might increase the risk of serious complications or death from COVID-19 infection. The authors noted that the coronavirus binds to its target cells through ACE2, which patients make in abundance when taking these drugs. This could increase the ability of the virus to enter the lungs and hijack the patient’s respiratory system, they postulated.
So do these drugs increase the danger from COVID-19? If you use one of these agents to control your blood pressure, should you stop taking it?
“There is no data,” says Cleveland Clinic preventive cardiologist Leslie Cho, MD. “This is a theory. There is no clinical or experimental evidence of a connection between these drugs and increased harm from COVID-19 exposure.”
Major heart groups agree. On March 17, the American Heart Association, American College of Cardiology and Heart Rhythm Society issued a joint statement advising patients not to stop taking their ACE inhibitor or ARB. European medical societies released similar statements a few days prior.
Where’s the Proof?
There is no doubt that patients with hypertension and heart disease who contract the virus are at increased risk for a serious outcome. Many of these patients take ACE inhibitors and ARBs. This means there is an association between the use of these drugs and complications, but it does not mean the drugs are responsible for causing worse problems. People with chronic obstructive pulmonary disease and cancer are at increased risk of complications and death from the COVID 19 as well.
The inability to overcome COVID-19 is more likely to occur in people who are weakened by another condition. “We see this with other viruses as well. This is why we tell patients with underlying medical conditions to get immunized against flu and pneumonia,” says Dr. Cho.
Why Not Stop Anyway?
The potential danger posed by this novel virus has everyone looking for ways to protect themselves and the ones they love. Making the decision to discontinue a medication without your doctor’s permission is never wise. In the case of ACE inhibitors and ARBs, it may have unintended consequences.
“We understand everyone feels vulnerable right now, but try to act rationally,” Dr. Cho pleads. “If you stop taking your blood pressure medications, and your blood pressure gets out of control, we can say with great certainty that there will be true harm.”
How to Protect Yourself
Until researchers are able to explore the potential impact of ACE inhibitors, ARBs and other common drugs on people exposed to the coronavirus, Dr. Cho suggests following the steps known to decrease the likelihood of becoming infected:
- Stay at home.
- Wash your hands with soap and water thoroughly and often.
- Avoid unnecessary contact with others.
- Cover your cough.
- Resist touching your face.
Fever is the primary symptoms of COVID-19. If you develop a fever, call your primary care physician immediately. Do not call your cardiologist.
“In some states, the HIPAA laws protecting patients’ privacy have been relaxed, so your provider can talk with you on the phone or do a virtual visit over Facetime,” says Dr. Cho.
Do not go to your doctor’s office or the Emergency Department. “If you do have the virus, you will put many other people, including doctors and nurses, at risk and if you don’t, you will put yourself at risk by exposing yourself” she says. Call first.