ACEi/ARB use in patients with COVID-19
There is evidence that the renin-angiotensin system is important in coronavirus infection and observational data suggesting worse outcomes in patients with hypertension and COVID-19. This has led to speculation that ACEi/ARB use is harmful in patients with COVID-19. However, the basic science is far more complicated and there are conflicting data. There is a no clinical evidence indicating direct harm of ACEi/ARB use in COVID-19 infection.
Due to the significant morbidity and mortality benefit of ACEi/ARB in many cardiovascular diseases, such as heart failure, there are widespread recommendations by national and international societies NOT to routinely stop ACEi/ARB in patients with COVID-19 infection.
These societies include;
The British Cardiovascular Society and The British Society for Heart Failure (https://www.britishcardiovascularsociety.org/news/ACEi-or-ARB-and-COVID-19)
The European Society of Cardiology (https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang)
The European Society of Hypertension (https://www.eshonline.org/spotlights/esh-stabtement-on-covid-19/)
Therefore, considering the pan-European and cross-specialty advice, patients in Cornwall who require ACEi/ARB therapy should NOT be routinely denied treatment due to COVID-19. This is particularly important given the significant benefits of ACEi/ARB therapy in cardiovascular disease and significant risks of worse outcomes with inappropriate drug withdrawal.
Dr Parminder Chaggar
RCH Consultant Cardiologist and Clinical Lead for Heart Failure