The coronavirus pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has swept across the globe, infecting more than 23.3 million people, and taking the lives of over 807,000. Data shows that the most severe cases occur in the elderly, those with weakened immune systems, and those who have underlying medical conditions, such as high blood pressure, diabetes, kidney disease, heart problems, and lung illness, among others.
Previous studies have also linked hypertension to severe coronavirus disease (COVID-19). Now, a new study by researchers at the University of East Anglia's Norwich Medical School has found that the risk of severe COVID-19 and death was reduced for patients with high blood pressure who were taking Angiotensin-Converting Enzyme inhibitors (ACEi) or Angiotensin Receptor Blockers (ARB).
Renin-angiotensin-aldosterone system (RAAS) inhibitors, which include ACEi and ARB, are a class of drugs used to treat high blood pressure.
Hypertension and COVID-19
Early in the pandemic, studies in hardest-hit countries like China and Italy have shown that there are higher morbidity and mortality rates among patients with a medical history of hypertension, diabetes, chronic kidney disease, coronary artery disease, and obesity.
The SARS-CoV-2 infects human cells through the angiotensin-converting enzyme 2 (ACE2) receptor, which acts as the gateway for the virus to enter and invade healthy cells. ACE2, the binding site of SARS-CoV-2, is a critical component of the counter-regulatory pathway of the renin-angiotensin-aldosterone system (RAAS), which is one of the most important regulators of blood pressure, inflammation, and fibrosis. It is also crucial to the pathophysiology of high blood pressure, heart disease, and kidney disease.
Survival rate improvement
The role of RAAS inhibitors, specifically ACEi and ARB, in the coronavirus pandemic, has not been thoroughly evaluated. With skyrocketing cases worldwide, it is vital to understand better the impact of these medicines in hypertensive patients infected with COVID-19.
In the current study, published in the journal Current Atherosclerosis Reports, the research team noted that blood pressure medicine improves survival rates from COVID-19 in people with hypertension. The new findings contradict previous research, showing that antihypertensives could make the coronavirus infection worse.
To arrive at the study findings, the research team looked at the effect of taking common medications on coronavirus patients with a range of medical conditions. They conducted a meta-analysis using sources such as PubMed, Embase, and the pre-print database medRxiv, searching for data on patients on antihypertensives with COVID-19.
The team gathered 19 studies related to COVID-19 and ACEi and ARB medications, which involved more than 28,000 patients. The researchers compared data from COVID-19 patients who are taking their antihypertensives with those who were not, focusing on whether the patients experienced critical events, such as being admitted to intensive care and being subjected to invasive or non-invasive ventilation, and death.
Patients with high blood pressure who continued taking antihypertensives were 0.67 times less likely to have a critical or fatal outcome than those who were not, the researchers concluded. However, for those who took the same medications for other conditions such as heart and kidney failure, stroke, and diabetes, their COVID-19 outcome was neither worse nor better.
"We found that a third of Covid-19 patients with high blood pressure and a quarter of patients overall were taking ACEi/ARBs. This is likely due to the increased risk of infection in patients with co-morbidities such as cardiovascular diseases, hypertension, and diabetes," Dr. Vassilios Vassiliou, from UEA's Norwich Medical School, said in a statement.
"But the really important thing that we showed was that there is no evidence that these medications might increase the severity of Covid-19 or risk of death," he added.
Dr. Vassiliou added that the research team found there is a lower risk of death and critical outcomes. Hence, drugs protected patients with hypertension.
"This is the largest meta-analysis including critical events and mortality data on patients prescribed ACEi/ARB and found evidence of beneficial effects of chronic ACEi/ARB use especially in hypertensive cohort with COVID-19," the researchers concluded.
"As such, we would strongly encourage patients to continue with RAAS inhibitor pharmacotherapy during the COVID-19 pandemic," they added.