{"id":37883,"date":"2020-05-14T08:27:13","date_gmt":"2020-05-14T08:27:13","guid":{"rendered":"http:\/\/i-base.info\/htb\/?p=37883"},"modified":"2020-05-15T02:58:07","modified_gmt":"2020-05-15T02:58:07","slug":"ace-inhibitors-and-angiotensin-receptor-blockers-do-not-boost-risk-of-covid-19-or-flu","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/37883","title":{"rendered":"ACE inhibitors and angiotensin receptor blockers do not boost risk of COVID-19 or flu"},"content":{"rendered":"

<\/b>Mark Mascolini, for NATAP.org<\/span><\/strong><\/p>\n

Large studies in the United States, Italy, and the United Kingdom (UK) should ease fears that taking angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) raise the risk of COVID-19 or influenza. [1, 2, 3] <\/span><\/strong><\/p>\n

In fact the UK study found that these popular antihypertensives\u00a0lower<\/i>\u00a0flu risk.<\/span><\/p>\n

Because SARS-CoV-2, the COVID-19 virus, uses angiotensin-converting enzyme 2 (ACE-2) to enter target cells, some feared that drugs interfering with the renin-angiotensin\u2013aldosterone system \u2013 like ACE inhibitors and ARBs \u2013 may make COVID-19 more likely. [1, 2]<\/span><\/p>\n

Influenza A (including subtypes H7N9, H1N1, and H5N1) uses the ACE-2 receptor to mediate lung damage. \u00a0[3]<\/span><\/p>\n

Researchers at New York University (NYU) in New York City analysed medical records of everyone tested for COVID-19 between 1 March and 15 April 2020. [1] Among 12,594 people tested, 5894 (46.8%) had COVID-19 and 1002 (17% of 5894) had severe illness (intensive care, mechanical ventilation, or death). More than one third (4357; 34.6%) had a history of hypertension, of whom 2573 (59.1%) had COVID-19 and 634 (24.6% of 2573) had severe COVID-19.\u00a0<\/span><\/p>\n

The NYU team assessed relations between previous treatment with ACE inhibitors, ARBs, beta-blockers, calcium-channel blockers, or thiazide diuretics and a positive or negative COVID-19 test plus the likelihood of severe illness among those with COVID-19.\u00a0Bayesian methods showed no association between any medication class and greater chance of a positive COVID-19 test or a substantially increased risk of severe COVID-19.\u00a0<\/span><\/p>\n

In Italy\u2019s Lombardy region, researchers matched 6272 people with SARS-CoV-2 infection to 30,759 people without the virus by age, sex, and municipality. [2]<\/span><\/p>\n

Both groups averaged 68 years in age and 37% were women. People with COVID-19 took ACE inhibitors and ARBs more often than the control group because they had a higher prevalence of cardiovascular disease.\u00a0But statistical analysis detected no association between ARBs or ACE inhibitors and COVID-19 risk overall or COVID-19 risk in people with a severe or fatal disease course.<\/span><\/p>\n

UK researchers used electronic health records to determine flu incidence in adults who got an ACE inhibitor, an ARB, or neither from 1998 through 2016. [3]<\/span><\/p>\n

While 700,994 people got an ACE inhibitor prescription, 230,028 were prescribed an ARB and 4,742,017 got neither drug or the direct renin inhibitor aliskiren. After a median 8.7 years of follow-up, an analysis adjusted for age, sex, smoking history, influenza vaccination, obesity, and 12 comorbidities determined that\u00a0people taking an ACE inhibitor had a one third lower risk of flu than those who did not (adjusted hazard ratio [aHR] 0.66, 95% confidence interval [CI] 0.62 to 0.70).\u00a0Taking an ARB halved the flu risk (aHR 0.52, 95% CI 0.47 to 0.57). Further analysis showed that the longer people took ACE or ARB agents, the lower their flu risk.<\/span><\/p>\n

Professional societies and expert panels recommend\u00a0not<\/u>\u00a0stopping ACE inhibitors or ARBs for fear that they may raise the risk of COVID-19 infection, severity, or death. [4, 5, 6]<\/span><\/p>\n

References<\/span><\/p>\n

    \n
  1. Reynolds HR et al. Renin\u2013angiotensin\u2013aldosterone system inhibitors and risk of Covid-19. N Engl J Med. DOI: 10.1056\/NEJMoa2008975.<\/b><\/span>
    \nhttps:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa2008975<\/a>\u00a0<\/span><\/li>\n
  2. Mancia G et al. Renin\u2013angiotensin\u2013aldosterone system blockers and the risk of Covid-19. N Engl J Med. DOI: 10.1056\/NEJMoa2006923.\u00a0<\/span>https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa2006923<\/a>\u00a0<\/span><\/li>\n
  3. Chung SC et al. Association between angiotensin blockade and incidence of influenza in the United Kingdom. N Engl J Med. May 8, 2020. DOI: 10.1056\/NEJMc2005396.\u00a0<\/span>https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMc2005396<\/a>\u00a0<\/span><\/li>\n
  4. American College of Cardiology. HFSA\/ACC\/AHA statement addresses concerns re: using RAAS antagonists in COVID-19. March 17, 2020.<\/span>
    \n    https:\/\/www.acc.org\/latest-in-cardiology\/articles\/2020\/03\/17\/08\/59\/hfsa-acc-aha-statement-addresses-concerns-re-using-raas-antagonists-in-covid-19<\/a>\u00a0<\/span><\/li>\n
  5. European Society of Cardiology. Position statement of the ESC Council on Hypertension on ACE-inhibitors and angiotensin receptor blockers. March 13, 2020.\u00a0<\/span><\/li>\n
  6. Vaduganathan M et al. Renin\u2013angiotensin\u2013aldosterone system inhibitors in patients with Covid-19. N Engl J Med 2020;382:1653-1659.<\/span><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Mark Mascolini, for NATAP.org Large studies in the United States, Italy, and the United Kingdom (UK) should ease fears that taking angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) raise the risk of COVID-19 or influenza. [1, 2, 3] …<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[284,278],"tags":[],"class_list":["post-37883","post","type-post","status-publish","format-standard","hentry","category-covid-19-complications","category-covid-19"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/37883","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=37883"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/37883\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=37883"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=37883"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=37883"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}