Patients treated with ACE inhibitors may be at risk for COVID-19 complications

A researcher at the Louisiana State University (LSU) School of Public Health may have an explanation for the increased risk COVID-19 poses for people with hypertension, coronary artery disease, and diabetes. His manuscript was published in the Journal of Travel Medicine by Oxford University Press this month.

James Diaz, M.D., DrPH, Professor and Head of Environmental Health Sciences at LSU, emphasizes that SARS beta coronaviruses enter the lungs by binding the angiotensin converting enzyme 2 (ACE2) receptor.

Patients who are treated with ACE inhibitors and ARB medications may have more ACE2 receptors and thus more places for SARS CoV-2 to bind. As a result, these people may be at greater risk for complications and even death from COVID-19.

"Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are highly recommended medications for patients with cardiovascular diseases including heart attacks, high blood pressure, diabetes and chronic kidney disease to name a few,” said Dr. Diaz. 

Diaz’s hypothesis comes from analyzing 1,099 patients whose COVID-10 infections were treated in China between December 11, 2019 and Jan. 29, 2020. More severe outcomes were reported for individuals with high blood pressure, coronary artery disease, diabetes and chronic kidney disease all of which are conditions ACE inhibitors or ARB medications are prescribed for.

Children on the other hand have fewer ACE2 receptors in their lower respiratory tracts. Diaz connects this to the observation that children have low risk for severe infection from COVID-19.

Diaz calls for more study of patients with COVID-19 to confirm potential connections between ACE inhibitors and ARB medications and COVID-19 complication susceptibility, but he also cautions that those individuals should not stop taking their medication.

"Patients treated with ACEIs and ARBs for cardiovascular diseases should not stop taking their medicine, but should avoid crowds, mass events, ocean cruises, prolonged air travel, and all persons with respiratory illnesses during the current COVID-19 outbreak in order to reduce their risks of infection," said Diaz.