ACE Inhibitors in the Time of Coronavirus


Are you worried about ACE inhibitors and coronavirus? You may be hearing that one of the entry methods for the coronavirus in humans is by attaching to the ACE-2 enzyme. This has raised alarms among those with heart disease who use ACE inhibitors (with names ending in -pril, such as lisinopril), and angiotensin II receptor blockers (ARBs, with names ending in -sartan, such as valsartan).

Those having severe cases of COVID-19 are often those with hypertension and either type 1 or Type II diabetes and those patients are often taking ACE-1 inhibitors and ARBs. Both diabetes and these drugs increase the expression of ACE-2 proteins. Many assume that having extra ACE-2 proteins, a known entry point for coronavirus into the system, would be a bad thing.

Here’s the confusing part: having more ACE-2 proteins may allow easier access by the coronavirus OR having more ACE-2 proteins may protect the lungs in those who get COVID-19. One of the long-term adverse effects of having COVID-19 is the possibility of compromised lung function.

Here’s a slightly technical explanation of why scientists argue both possible outcomes of using ACE inhibitors. The author of the quote is basing his thoughts on reports coming out of China. He states that “a mechanism of lung injury during the viral infection may be through inappropriate effects of excess free angiotensin-II protein, which is floating around out there because the ACE-2 that would normally be soaking it up is occupied by coronavirus particles. If that’s the problem, then increasing the amount of ACE-2 protein might paradoxically be just what you want to do to restore some balance to the angiotensin system. In that case administering more angiotensin receptor antagonists would be an effective way to upregulate the production of ACE-2.” From: Angiotensin and the Coronavirus, Science Translational Medicine, March 17, 2020

Conclusion? We don’t know if ACE inhibitors help or harm the progress of COVID-19. We do know that ACE inhibitors and ARBs are needed to manage heart disease. Therefore, all of the major organizations are recommending continuing your heart medication.

Studies and reviews of cases are ongoing, so stay informed and check in with MedShadow. For more on ACE inhibitors and alternatives drugs, see The Top Heart Meds: Risks vs. Benefits.

Here are some of the recommendations:

“The European Society of Cardiology (ESC) Council on Hypertension strongly recommends that physicians and patients should continue treatment with their usual anti-hypertensive therapy because there is no clinical or scientific evidence to suggest they cause any harm in COVID-19 infections.”

ESC Council on Hypertension Says ACE-I and ARBs Do Not Increase COVID-19 Mortality

Diagnostic and Investigational Cardiology – March 16, 2020

“Patients with cardiovascular disease diagnosed with novel coronavirus (COVID-19) are urged to continue taking their angiotensin-converting enzyme inhibitor (ACEi) and angiotensin receptor blocker (ARB) medications as prescribed, according to a statement jointly published by the American Heart Association (AHA), the Heart Failure Society of America (HFSA), and the American College of Cardiology (ACC).”

Joint Statement Issued Addressing Concerns Over COVID-19 and ACE Inhibitor, ARB Use

MPR – March 18, 2020

A couple of articles for a more scientific explanation and the Washington Post’s excellent recap:

Angiotensin and the Coronavirus

Science Translational Medicine – March 17, 2020

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Lancet – March 1, 2020

Coronavirus is especially threatening for people with heart disease

Washington Post – March 20, 2020