Routine Antihypertensives Safe for COVID-19 Patients

Medications used to treat hypertension found to be neither beneficial or harmful in the treatment of hospitalized COVID-19 patients.

Medications to treat high blood pressure did not influence clinical outcomes among patients hospitalized with COVID-19, according to an international team led by researchers in the Perelman School of Medicine at the University of Pennsylvania.

The study, published in The Lancet Respiratory Medicine, is a randomized controlled trial to show there is no risk for patients using antihypertensive medications while hospitalized for COVID-19.

‘Hypertensive patients should continue using ACEI and ARB therapy even during hospitalization due to COVID-19.’
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Researchers examined is ACE inhibitors (ACEIs) or Angiotensin Receptor Blockers (ARBs) could help reduce complications or lead to more severe symptoms.

41 million Americans take an ACEI or ARB, according to the Centers for Disease Control and Prevention.

Some studies had suggested that these medications could upregulate cellular receptors for the SARS-CoV-2 virus potentially aiding viral replication. But, it was also considered that few effects could be protective against the virus.

ACE Inhibitors, Angiotensin Receptor Blockers may Raise Severe COVID-19 Risk
Patients who take ACEIs and ARBS may be at increased risk of severe disease outcomes due to SARS-CoV-2 infections.

"Observational studies were rapidly done, but randomized trials are important to establish a definitive answer regarding the potential impact of these commonly used blood pressure medications in the setting of COVID-19," said study corresponding and senior author Julio A. Chirinos, MD, PhD, an associate professor of Cardiovascular Medicine in the Perelman School of Medicine.

"Our trial results importantly show that these medications can be safely continued for patients hospitalized with COVID-19."

Various studies suggested no link between outpatient ACEI or ARB use and risk of COVID-19 hospitalization, but high-quality randomized trial evidence was lacking, till now.

Investigators enrolled 152 participants across several countries between March 31 and August 20, 2020, who were hospitalized with COVID-19 and already using one of the medications. They were randomly assigned to either stop or continue taking their prescribed medication.

Investigators developed an innovative global rank score to classify patient outcomes based on four factors: time to death, length of time supported by mechanical ventilation or extracorporeal membrane oxygenation (ECMO), length of time on renal replacement therapy, and a modified sequential organ failure assessment score.

By analyzing the patient outcome data, the team found discontinuation of ACEIs and ARBs compared with continuation of these medications had no effect on the global rank score.

The findings supports international society recommendations for continuing ACEI and ARB therapy in patients admitted to the hospital with COVID-19, unless there is a clear, alternate medical issue with ongoing therapy.

"At the start of the pandemic, patients were worried about perceived harm based on limited and incomplete information, and unfortunately, some insisted on stopping their medications. However, stopping these medications unnecessarily can increase the risk for severe complications, including heart attack and stroke," said first author Jordana B. Cohen, MD, MSCE, an assistant professor in the division of Renal-Electrolyte and Hypertension, and a co-principal investigator with Chirinos.

"Now we have high quality evidence to support our recommendation that patients continue to take these medications as prescribed."

The trial was sponsored by the investigators from the various enrolment centers; the REPLACE COVID Trial Social Fundraising Campaign supported a portion of enrolment at Penn Medicine; FastGrants supported enrolment at the University of Michigan.

Source-Medindia