Several American and European cardiology societies issued statements to dispel misinformation circulating about an association between treatment with renin-angiotensin-aldosterone system antagonists such as ACE inhibitors and angiotensin receptor blockers and increased risk for COVID-19 and increased severity of the disease for those who have contracted COVID-19.

The American Heart Association, the Heart Failure Society of America and the American College of Cardiology issued a joint statement on March 17 and the European Society of Cardiology issued a statement on March 13.

Renin-angiotensin-aldosterone system (RAAS) antagonists are commonly prescribed treatments for patients with hypertension, HF and/or ischemic heart disease.

Speculative hypotheses

“Based on initial reports from China, and subsequent evidence that arterial hypertension may be associated with increased risk of mortality in hospitalized COVID-19-infected subjects, hypotheses have been put forward to suggest a potential adverse effects of ACE inhibitors or angiotensin receptor blockers,” Giovanni de Simone, MD, FACC, FAHA, FESC, chair of the ESC Council on Hypertension and professor of medicine at Hypertension Research Center Federico II University Hospital, Naples, Italy, wrote on behalf of the ESC. “It has been suggested, especially on social media sites, that these commonly used drugs may increase both the risk of infection and the severity of SARS-CoV-2. The concern arises from the observation that, similar to the coronavirus causing SARS, the COVID-19 virus binds to a specific enzyme called ACE2 to infect cells, and ACE2 levels are increased following treatment with ACE inhibitors and angiotensin receptor blockers.”

The American Heart Association, the Heart Failure Society of America and the American College of Cardiology issued a joint statement on March 17 and the European Society of Cardiology issued a statement on March 13.
Source: CDC

The issue was raised in correspondence to The Lancet Respiratory Medicine by Lei Fang, MD, PhD, postdoctoral researcher in the department of biomedicine at University Hospital Basel, Switzerland, and colleagues.

“We suggest that patients with cardiac diseases, hypertension or diabetes who are treated with ACE2-increasing drugs are at higher risk for severe COVID-19 infection and, therefore, should be monitored for ACE2-modulating medications, such as ACE inhibitors or angiotensin receptor blockers,” Fang and colleagues wrote.

These reports, which have spread to social media, have led some patients to stop taking RAAS antagonists. However, patients should not stop treatment unless advised by a physician, according to the society statements.

“This speculation about the safety of ACE inhibitor or angiotensin receptor blockers treatment in relation to COVID-19 does not have a sound scientific basis or evidence to support it,” de Simone wrote in the ESC statement. “Indeed, there is evidence from studies in animals suggesting that these medications might be rather protective against serious lung complications in patients with COVID-19 infection, but to date there are no data in humans. The Council on Hypertension strongly recommends 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 ACE inhibitors or angiotensin receptor blockers should be discontinued because of the COVID-19 infection.”