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Currently, in the absence of scientific evidence, a withdrawal of ACEis or ARBs is not recommended in hypertensive patients.
Dr Maria José Soler, nephrologist at the Nephrology Service of the Vall d'Hebron University Hospital and member of the NephJC group. The Coronavirus Conundrum: ACE2 and Hypertention edition has participated in the position statement on the use of antihypertensive drugs such as ACEis or ARBs in patients infected with the SARS-CoV-2 virus and with hypertension prepared by the group. The document, which has been published in the kidney News Online journal of the American Society of Nephrology, recommends not stopping ACEIs or ARBs treatment in patients with confirmed COVID-19.
Angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor antagonists (ARBs) are common treatments for high blood pressure.
Several organizations (American College of Physicians, the European Society of Cardiology, Hypertension Canada, the Canadian Cardiovascular Society, UK Renal Association, and the International Society of Hypertension, among others) have released statements corroborating this approach.
The current pandemic associated with the SARS-CoV-2 virus and COVID-19 disease is unprecedented, and healthcare professionals face many challenges, including whether the combination of drugs for chronic diseases influences the severity of the patient with coronavirus.
In this sense, aware of this concern, doctors and researchers, among whom is Dr. Soler, who is also a principal investigator of the Nephrology group of the Vall d'Hebron Research Institute (VHIR), have prepared a consensus document on role of preliminary reports and articles that have appeared in different magazines on the role of angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor antagonists (ARBs) in the regulation of the expression of the gene of the angiotensin-converting enzyme 2 (ACE2). Several publications have pointed out that ACEis and ARBs agents could increase the regulation of ACE2 and, therefore, improve or facilitate the entry of SARS-CoV-2 into cells. Because the SARS-CoV-2 virus utilizes components of the renin angiotensin system (RAS) (ACE2 and TMPRSS2) to enter cells, it seemed plausible that ACEis and ARBs might exacerbate or even mitigate COVID-19.
Dr. Soler believes that "currently, in the absence of scientific evidence, a withdrawal of ACEis or ARBs is not recommended in hypertensive patients". "However, in patients with confirmed COVID-19 and who are receiving ACEi/ARB agents, , decisions on continuing or stopping these drugs should be done on an individualized basis by the treating physician", he points out.
This document will be updated based on new preclinical and clinical evidence, highly necessary at present.
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