What to Know About Diabetes, Blood Pressure Meds and COVID-19

  • The concern began after a study in The Lancet stated that ibuprofen boosts the angiotensin converting enzyme 2 (ACE2), which may facilitate and worsen COVID-19.
  • The World Health Organization warned most patients to stick with acetaminophen. Now they say they do not advise against using ibuprofen.
  • Most cardiologists advise patients to stay on their medications.

Could people on certain medications for hypertension, cardiovascular disease, and diabetes be at risk for experiencing COVID-19 more severely?

The question raises more concerns about which medications may make COVID-19 worse in some people. It follows reports that ibuprofen could do more harm than good in patients with COVID-19.

Understanding the theory

The concern began after a study in The Lancet stated that ibuprofen boosts the angiotensin converting enzyme 2 (ACE2), which may facilitate and worsen COVID-19.

As a result, the World Health Organization (WHO) originally warned most patients to stick with acetaminophen, which is also known as paracetamol. Now they say they do not advise against using ibuprofen.

The study explained that COVID-19 binds to ACE2 in order to target cells. Patients likely have increased ACE2 expression if they’re treated with ACE inhibitors, angiotensin II type I receptor blockers (ARBs) and thiazolidinediones. Those drugs are commonly taken by those with cardiovascular disease, hypertension, and diabetes. Ibuprofen can also increase ACE2, the study noted.

Cardiovascular, diabetes drugs in question as well

While media reports focused on ibuprofen, many did not highlight the other drug warnings in the journal article.

“We therefore hypothesize that diabetes, cardiovascular disease, and hypertension treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19,” the authors wrote. They said patients with cardiac diseases, hypertension, or diabetes who use drugs that increase ACE2 could be at higher risk for severe COVID-19 and, therefore, should be monitored.

In a separate article, lead author Dr. Michael Roth-Chiarello, who heads up a pulmonary cell research unit at the University Hospital of Basel in Switzerland, said that there needs to be more research into the use of ACE inhibitors in those with COVID-19. He did not respond to a request for comment.

Doctors: Evidence lacking

So, are patients on some hypertension, cardiovascular disease, and diabetes drugs at risk for more severe COVID-19?

This speculation about the safety of ACE or ARB treatment in relation to COVID-19 “does not have a sound scientific basis or evidence to support it,” Jared Van Hooser, assistant professor in the department of pharmacy practice and pharmaceutical sciences at the University of Minnesota College of Pharmacy and a clinical pharmacist at St. Luke’s Mount Royal Medical Clinic, told Healthline.

“Should people be aware that there is a possibility COVID-19 could be more severe in those with hypertension, cardiovascular disease, or diabetes? Yes, they should be aware, but the research is not definitive,” Van Hooser said.

The Council on Hypertension of the European Society of Cardiology has stated there’s a lack of any evidence supporting harmful effects of ACE and ARB with regard to COVID-19.

“[We] strongly recommend that physicians and patients should continue treatment with their usual antihypertensive therapy because there is no clinical or scientific evidence to suggest that treatment with ACEi or ARBs should be discontinued because of the COVID-19 infection,” the organization said in a statement.

Further research is needed to evaluate interactions between ACE inhibitor drugs and the virus that causes COVID-19. Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, has expressed support for further research in this area.

“There has been worse COVID-19 in patients on treatment for some chronic diseases like hypertension, but it’s impossible right now to separate whether this is due to the underlying disease versus the drugs being used,” explained Dr. Otto O. Yang, a professor of infectious diseases at the David Geffen School of Medicine at UCLA, told Healthline.

Rory Remmel, PhD, a professor at the University of Minnesota College of Pharmacy, cited the BMJ report that said patients taking lisinopril or angiotensin receptor blocking agents such as losartan could have increased ACE2 in the lungs. ACE2, the study authors noted, could make COVID-19 worse.

But there’s a flip side.

“Interestingly, losartan is one of the medically approved drugs that is being tested for treatment of COVID-19 on the theory that it will block viral entry,” he told Healthline. The virus binds to ACE2, but losartan blocks ACE2 from entering cells — making it a potential therapy.

Dr. James Louis Januzzi, a cardiologist at Massachusetts General Hospital, said people need to be careful about getting medical advice from anyone other than their own doctors.

“Don’t believe the misinformation that is going on out there,” he said. “Everyone is scared and wants to provide rapid, useful information to people.”

“Unless and until prospective randomized data are available, people should not assume anything they read is true, and they should speak to their physician if they have questions,” Januzzi added.

Stay on your meds, doctors warn

Most cardiologists — including the American Heart Association, American College of Cardiology, and Heart Failure Society of America — advise patients to stay on their medications.

“People should not stop taking their medications unless directed by a healthcare professional,” Van Hooser said. “We want to avoid a knee-jerk reaction to something that does not have evidence or very limited evidence.”

Concerned about taking these medications and getting COVID-19? Dr. Michael Miller, a cardiologist and professor at the University of Maryland School of Medicine, said to stay on your medications and talk to your doctor about concerns.

“We are not recommending that our patients stop taking these medications,” he told Healthline.

The only way a doctor would recommend stopping the medication is if the patient has complications from COVID-19, Miller said.

“However, if they develop COVID-19 and have complications that result in significant hypotension, ACE inhibitors will almost invariably be temporarily discontinued,” he noted.

Stay on your medications, Januzzi echoed.

“It actually could be harmful to stop these meds abruptly,” Januzzi said. “To be explicitly clear, we have no good, prospective comparative data to suggest taking drugs like ACE inhibitors is harmful or beneficial relative to COVID-19 infection.”

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