Could Blood Pressure Drugs Raise The risk of COVID-19?

Tissue-specific look at how blood pressure medications affect SARS-CoV-2 receptors could help identify whether blood pressure and heart patients are at increased risk of contracting COVID-19.

Mice treated with an ACE inhibitor (blood pressure medication) showed raised levels of ACE2. But, mice that received both an ACE inhibitor and a different blood pressure medicine known as an angiotensin receptor blocker (ARB) did not exhibit the raise.

SARS-CoV-2 binds to a cellular receptor known as angiotensin converting enzyme 2 (ACE2) before entering a cell and replicating.

‘Blood pressure medications may change disease risk and severity for COVID-19. And, this has been an intense ongoing area of debate during the pandemic.’
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"Based on these findings, we recommend that researchers analyze existing and ongoing clinical studies to determine whether people on ACE inhibitor-ARB combination therapy show different COVID-19 susceptibility, complications and outcomes than patients taking only an ACE inhibitor or ARB medication," said Steven Brooks, PhD, a post-doctoral research fellow in the Ackerman laboratory.

Researchers treated healthy mice with either the ACE inhibitor lisinopril or the ARB losartan alone, in combination, or a placebo. After three weeks, they measured levels of ACE2 in the lung, small intestine, brain and kidney.

They also examined the brain and kidney because people with COVID-19 often develop complications in these organs.

Excess ACE2 molecules varied significantly depending on the tissue type. For mice that received the placebo, the levels of ACE2 in the small intestine was ten times higher than in the kidney and 100 times higher than in the brain or lung.

Lisinopril raised the level of ACE2 molecules across all four tissues while losartan raised ACE2 only in the small intestine after three weeks. Mice treated with both lisinopril and losartan did not show increased levels of ACE2 in any tissue.

Three weeks after treatment stopped, the levels of ACE2 no longer differed among the groups of mice, indicating that discontinuing either blood pressure medication returns ACE2 levels to the those found in placebo-treated mice.

"These results provide a controlled, tissue-specific analysis of the effects of ACE inhibitors, ARB and combination therapy on the levels of ACE2 in healthy mice," said Ackerman.

Coronavirus
Coronaviruses infect animals, humans, and birds. Human coronaviruses, such as SARS, MERS, and 2019-nCoV cause respiratory distress and even death. The S protein is the infectious agent of the virus.

"Our findings that ACE inhibitor treatment increases tissue expression of ACE2 are in agreement with a previous study in rats that showed ACE2 increased in heart tissue, and a separate study in rats that showed ACE2 increased in lung tissue, following treatment with ACE inhibitors."

ACE inhibitors and ARBs -- change disease risk and severity for COVID-19 has been an intense ongoing area of debate during the COVID-19 pandemic.

"Thus far, clinical studies have not identified an increase in COVID-19 risk or severity among in people taking these drugs," said Ackerman. "We recommend that patients taking heart medications work with their healthcare providers to manage their medications."

Source-Medindia