Hypertension patients told not to stop meds

The Heart Foundation says routine use of ARB and ACE inhibitors should continue, after concerns were raised about worse outcomes with COVID-19

newsGP reports that doctors have been querying the effect of these medicines on patients with COVID-19 and expressing concern as to how they should advise their patients.

Dr Evelyn Lewin wrote that “the issue surrounding ACE-inhibitors and ARBs stems from the fact the COVID-19 virus binds to the ACE-2 receptor, according to Associate Professor Nathan Better, cardiologist and deputy director of nuclear medicine at Royal Melbourne Hospital and private cardiologist at Cabrini Hospital”.

A/Prof Better said that the COVID-19 virus binds to the ACE-2 receptor, and that “what we know is that ARBs… increase the expression of the ACE-2 protein in the body as many as three to five times” thus giving the novel coronavirus a “portal to entry”.

However he stressed that he did not advise patients to stop taking their medicines because of these concerns and noted that no clinical trials had shown that people taking these antihypertensives had worse COVID-19 outcomes than other patients.

The Heart Foundation has said in a statement that it recommends the routine use of ARB and ACE inhibitor medications should continue in the treatment of hypertension, heart failure, secondary prevention of acute coronary syndrome and other chronic conditions.

“The suggested link between COVID-19 and ARBs and ACE inhibitors is based on the observation that these antihypertensives increase levels of the ACE2 enzyme in the body, the same enzyme that the SARS coronavirus uses to infect the body,” Heart Foundation Chief Medical Adviser, cardiologist Professor Garry Jennings said.

“We want to highlight that at this stage, there is no clinical data from people infected with the COVID-19 virus to confirm this theory.

“Given the lack of clinical evidence at this stage, and the known benefits of ARB and ACE inhibitor medications, the Heart Foundation is advising patients continue to take all their medications, including ARBs or ACE inhibitors, as prescribed by their doctor.”

Professor Jennings said that it is understandable and important for both patients and health professionals to be concerned when there are reports about possible harms from medications, but stopping these medications abruptly can do more harm than good.

“There is the potential for serious harm if people stop taking their ARB and ACE inhibitor medications,” he warned the general public.

“These medications have demonstrated substantial benefits in reducing risk of death, cardiovascular events and hospitalisations in the secondary prevention of acute coronary syndromes and the treatment of hypertension, heart failure, and other chronic conditions.

“Further research into the relationships between specific medicines and COVID-19 is ongoing.”

Meanwhile the Foundation has cancelled this year’s Heart Week activities due to COVID-19.

The national heart health awareness week was planned for early May, with a focus on engaging with the primary care sector to raise the number of patients getting their CVD risk assessed.

Heart Foundation Group CEO, Adjunct Professor John Kelly, said the challenges in the current health environment meant Heart Week 2020 activities would not go ahead.

“We haven’t reached this decision easily. Our number one priority is to ensure all people who engage with Heart Foundation activities are safe and that we are supporting our general practice and hospital sectors as much as possible during these challenging times,” Prof Kelly said.

“We would like to acknowledge the incredible efforts of our doctors, nurses and allied health staff and we understand their role in fighting this pandemic is vital to keeping Australians safe.

“We urge people living with heart disease to take precautions to avoid infection with COVID-19, and to continue taking their medications as prescribed by their doctor.”

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