Some authorities saying that you should NOT stop taking your BP meds (ACE inhibitors) out of CV fear

[mr_lebowski]

https://www.escardio.org/Councils/Council-on-Hypertension-%28CHT%29/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang

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.

[lpbk2713]

1. Thanks.

I wasn't sure.

[Warpy]

2. In the absence of clear guidance from the CDC

and other public health organizations, there will be a lot of crackpot advice out there. Don't take it. Your doctor's office will be your best guide, not some quack on the internet or anywhere else.

By the time this is over, we might know about some problems with drugs but we don't know it as yet. Epidemiology studies are being done in China, but we won't know most of those results for a good six months and other countries will follow them.

[womanofthehills]

4. Covid 19 latches onto ACE2 to enter cells & ACE inhibitors increases ACE2 in the body

So, that sounds kind of scary to me. The study was done by scientists from the Univ Hospital Basel in Switzerland and the Univ of Thessaloniki in Greece.

ACE2 is angiotensin-converting enzyme and ACE inhibitors increase this enzyme - so you have more receptors for Covid 19 to enter - basic premise. No problem with calcium channel blockers.


The CDC under Trump is not an agency I trust for guidance.

[intrepidity]

6. Thank you for posting that

I didn't know that ibuprofen increased ACE2.

[Warpy]

7. Thank you for posting, but I find tiny studies not entirely convincing.

If anyone on an ACE inhibitor is concerned about this, a call to the physician is in order. Certainly some will prescribe a different antihypertensive to bridge the 4 months or so this is going to take to run its course.

Stopping an ACE inhibitor because of articles like this is unwise without a different strategy in place to control hypertension.

This is the type of thing that will be confirmed or disproven in about a year or so when the epidemiological data are in offshore, where universal care will make certain light cases as well as severe ones are counted.

Certainly this is something that is going to have to be watched very closely. While they've identified a possible mechanism in people under treatment for comorbidities like simple hypertension and metabolic syndrome, they could very well find out the correlation in untreated patients is even higher.

TlDr: If you are on an ACE inhibitor and this worries you, talk to your doctor about switching to a different type of medication. This study is far too limited to draw any real conclusions from and suddenly stopping a drug because of it is not smart.

[octoberlib]

10. I would think that if all the doctors treating COVID

patients noticed that all the people on ACE inhibitors were getting severely ill or dying they would have said something just like the French foreign minister and other doctors did with ibuprofen. Something like this would be noticeable and they’d issue at the least a cautionary statement to switch to a different class of drugs.

[PoindexterOglethorpe]

3. Well of course not.

If you need the meds, take them.

If you have doubts about the meds you're taking, you need to discuss it with your doctor. Whatever those meds are.

[mr_lebowski]

5. The study mentioned in post 4 has been making the rounds

And there's apparently been confusion even among doctors WRT what it means. The statement I linked to is specifically meant to advise doctors as well as patients.

[roamer65]

8. An ARB will actually make it more difficult for the virus to get into cells.

ARB’s like Valsartan or Losartan compete with CV for cells AT1 receptors.

In biological terms, it is called competitive binding. Studies have indicated that those who are using ARB’s tending to have less occurrences of colds and flu.

[intrepidity]

9. The Lancet paper above says ARBs upregulate ACE2

Do you have any citations I can read on this? Thanks

[roamer65]

12. ..

http://atm.amegroups.com/article/view/12396/html

[intrepidity]

13. Thank you.

I'll have to read that at least 3 times, but I approve of the approach. Lots of great info and cites for me to follow.

What's clear is that the picture is very complex.

I've only begun to scratch the surface, but something I read elsewhere gave the impression that ACE2 needs to dimerize in order for the virus to activate the infection process (internalization). So, perhaps increased ACE2--rather than simply providing more targets for virus--actually provides more opportunities for dimerization. If I were designing a therapeutic, I might look at preventing ACE2 homodimerization. Unless, of course, it's needed for it's usual functioning. I just don't know enough.

Competitive binding doesn't seem to be what's happening with ARBs. It seems much more likely that it's the immune responses (and other cascades), based on all the evidence presented in the paper you linked (that is, the effects in absence of virus).

I'm just beginning to try to even understand this area of research.

[roamer65]

16. I can't answer for ACE2 inhibitors.

ARB’s do not seem to be as problematic. I use Valsartan and since my BP was up I went back to the prescribed dose.

In my research I have found papers like this one.

[Drahthaardogs]

11. And this is wht chloroquine appears to work

It impedes the virus binding with ACE2

[intrepidity]

14. Do you have a citation for that?

Thanks

[Drahthaardogs]

15. There are several out there

Most is in vitro non in vivo, but, the South Koreans apparently used it with some success

[intrepidity]

17. Ok I'll look, thanks

In vitro data is fine with me, I'm interested in the mechanism.