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 Renal Association (https://renal.org/covid-19/ra-resources-renal-professionals/renal-association-uk-position-statement-covid-19-ace-inhibitorangiotensin-receptor-blocker-use/)

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

Royal Cornwall Hospital

Truro

Cornwall TR1 3LJ

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