Friday, 20 March 2020

Covid-19 virus and hypertensive drugs, no cause for concern - American Heart Association and European Society of Cardiology

covid-19 and hypertensive drugs. www.dicardiology.com
At a time when world leaders from US  President Don Trump to PM Modi of India  call for concerted efforts to face the dreaded corona virus pandemic with patience and collective determination so that the humanity and the nation will prevail, in the back drop  there has been a controversial discussion going on among health experts with respect to Covid-19 and the use of hypertensive medication.  
The drugs come under the class of  Angiotensin-Controlling  Enzyme (ACE) inhibitors and Angiotensin Receptor Blockers (ARBs). One of the highlighted concerns as gained wide currency on Social media is in severely affected  countries such as Italy it  indicated a poor outcome for COVID-19 patients who have been taking these drugs for an underlying condition. The media reports from Italy  said 99% of people who died had an underlying condition, and in 75% of these cases, that condition was hypertension. 

Because Angiotensin Converting Enzyme2 (ACE2) receptors have been shown to be the entry point into human cells for SARS-CoV-2, according to medical  reports, Dr. Anthony Fauci , director of the National Institute of Allergy and Infectious Diseases,USA said in a discussion with the Journal of the American Medical Association that was ''an extrapolation, and not based on data''.

Citing data from China, the European Society of Cardiology (ESC) expressed its main concern in March, 2020   because it was  reported that just as in the case of the coronavirus causing SARS [Severe Acute Respiratory Syndrome], “the COVID-19 virus binds to a specific enzyme called ACE2 to infect cells, and ACE2 levels are increased following treatment with ACE-i and ARBs.”

Not withstanding conflicting statements on ACE inhibitor drugs  vis-a-vis covid -19 virus, the Council of Hypertension of the ESC (European Society of Cardiology),  said it “strongly recommended” that doctors and patients should continue with their usual anti-hypertensive therapy in the absence of “clinical or scientific evidence to suggest that treatment with ACE-i or ARBs should be discontinued because of the COVID-19 infection.”

The  controversial issue has assumed a serious repercussion bordering on alarm  as  some patients were voluntarily stopping ACE inhibitors and ARBs, which are commonly prescribed for many cardiovascular diseases and to protect against damage to the kidneys, including among diabetics.

The American College of Cardiology, American Heart Association and Heart Failure Society of America  finally chipped in to alley fear among patients and issued a joint advisory on March 17, urging that ''patients who were currently taking these drugs should continue to take them''.
The statement further pointed out that “These theoretical concerns and findings of cardiovascular involvement with COVID-19 deserve much more detailed research, and quickly.” .....''Currently there are no experimental or clinical data demonstrating beneficial or adverse outcomes with background use of ACE inhibitors, ARBs or other RAAS antagonists [which influence hypertension] among COVID-19 patients with a history of cardiovascular disease treated with such agents.''
 Tit-bits:
Hypertension. www.verywellhealth.com/
01. The U.S. National Library of Medicine has listed  nine commonly used ACE-inhibitors (such as enalapril and ramipril) and seven ARBs (such as losartan, telmisartan and olmesartan);  many of these are widely prescribed by doctors across India.

02. ''The Food and Drug Administration  of the USA has recently recalled a number of blood pressure medications after discovering that they contained potential cancer-causing contaminants. Torrent Pharmaceuticals Limited expanded its voluntary recall for losartan potassium tablets and the combination medication, losartan potassium/ hydrochlorothiazide tablets. Other lots of losartan as well as other drugs from several manufacturers have been recalled voluntarily in recent months as well due to contamination from other chemicals.  The drugs from Torrent, with lot numberslisted on the FDA website were believed to be contaminated with "unacceptable" amounts of N-methylnitrosobutyric acid or NMBA, a potential human carcinogen. Please refer to (https://abcnews.go.com/Health/blood-pressure-medication-recall/story?id=59585424)..........................................
https://www.thehindu.com/sci-tech/health/coronavirus-do-anti-hypertensive-drugs-raise-the-risk-for-covid-19-patients/article31113082.ece
 https://www.dicardiology.com/content/esc-council-hypertension-says-ace-i-and-arbs-do-not-increase-covid-19-mortality
http://www.pulsetoday.co.uk/clinical/clinical-specialties/cardiovascular/gps-should-continue-with-ace-inhibitors-and-arbs/20040353.article






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