ACE-Inhibitor and Angiotensin Receptor Blocker use during the COVID-19 outbreak
Many of you will be aware of recent media reports suggesting a potential connection between the use of angiotensin converting enzyme inhibitors (ACE-i) or Angiotensin Receptor Blockers (ARBs) and the risk and severity of COVID-19 infection.
This speculation about the safety of ACE-i or ARB treatment in relation to COVID-19 arises from the observation that the COVID-19 virus binds to a specific enzyme called ACE2 to infect cells and that ACE2 levels are increased following treatment with ACE-i and ARBs. This speculation, however, does not have a sound scientific basis or evidence to support it. Indeed, there is evidence suggesting that these medications might, in fact, be protective against serious lung complications in patients with COVID-19 infection.
In particular, in the population of patients with heart failure and reduced ejection fraction (HFrEF), these drugs are essential for reducing both morbidity and mortality. Their use is supported by over 30 years of clinical trial and real-world data. Moreover, there is evidence demonstrating that withdrawal of ACE-i and ARBs in HFrEF patients is associated with higher rates of mortality and hospital readmission.
Based on the current evidence, King’s Health Partners cardiovascular department strongly recommends that all patient using ACE-i/ARB for hypertension, post MI LV dysfunction, hypertension, ischaemic heart disease, and heart failure with reduced ejection fraction should continue treatment with their usual therapy during the COVID-19 outbreak.
Patients or physicians who have concerns regarding heart failure management should contact the respective HF teams for advice.
This advice is provided in conjunction with the following societies, who highlight the lack of any convincing clinical or scientific evidence supporting a harmful effect of ACE-I and ARB in the context of the pandemic COVID-19 outbreak and recommend continuation of these medications in patients with both heart failure and hypertension: