What are your thoughts on anti-hypertensive medications such as Losartan as far as how they could influence the severity of an infection?
Along the same lines, when we are told that high blood pressure is a risk factor, does that mean treated or untreated?
I have seen thoughts on both sides, some suggesting that because the virus binds to ACE2 as its means of entry into the body, that drugs which increase expression of that enzyme such as Losartan would lead to worse outcomes(which seems to be supported by the stats on hypertension as a comorbidity), but there are others saying that the increase in ACE2 has actually been shown to be protective and has been shown to prevent lung damage in other instances of viral pneumonia and ARDS, with some theorizing it could even be used as a treatment for covid19. But I'm not a doctor so I dont know what to think of it all since the info is so contradictory.
If your parents were on Losartan, would you have them continue taking it or try to switch to a calcium channel blocker or something else?
This is a great question.
Losartan is a angiotensin receptor blocker. It is somehow related to ACE inhibitors (which blocks conversion of angiotensin). Losartan may increase expression of the receptor (upgregulation) and upstream increase production of angiotensin 1 but as of now, there is insufficient data to say much about its effect on COVID expression or infection. HOWEVER, if you have high BP, it would make sense to switch to something like a CCB (norvasc or adalat)
Here's a paper published in the lancet: https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(20)30116-8.pdf
Thank you. My mom takes it. I'll let her doc know.
It's worth talking about, but seems like there's no clear answer. I'm not a doctor
Position Statement of the ESC Council on Hypertension on ACE-Inhibitors and Angiotensin Receptor Blockers
13 Mar 2020
Based on initial reports from China, and subsequent evidence that arterial hypertension may be associated with increased risk of mortality in hospitalized COVID-19 infected subjects, hypotheses have been put forward to suggest a potential adverse effects of angiotensin converting enzyme inhibitors (ACE-i) or Angiotensin Receptor Blockers (ARBs). It has been suggested, especially on social media sites, that these commonly used drugs may increase both the risk of infection and the severity of SARS-CoV2. The concern arises from the observation that, similar to the coronavirus causing SARS, the COVID-19 virus binds to a specific enzyme called ACE2 to infect cells, and ACE2 levels are increased following treatment with ACE-i and ARBs.
Because of the social media-related amplification, patients taking these drugs for their high blood pressure and their doctors have become increasingly concerned, and, in some cases, have stopped taking their ACE-I or ARB medications.
This speculation about the safety of ACE-i 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.
The Council on Hypertension of the European Society of Cardiology wish to highlight the lack of any evidence supporting harmful effect of ACE-I and ARB in the context of the pandemic COVID-19 outbreak.
The Council on Hypertension strongly recommend that physicians and patients should continue treatment with their usual anti-hypertensive therapy because there is no clinical or scientific evidence to suggest that treatment with ACEi or ARBs should be discontinued because of the Covid-19 infection.
Prof. Giovanni de Simone,
Chair, ESC Council on Hypertension
On behalf of the Nucleus Members