Does Lisinopril increase your risk for severe Coronavirus (COVID-19) symptoms? Lisinopril is an ACE inhibitor used to lower blood pressure. It protects the heart from remodeling that may occur in diabetes or heart failure. In this blog, I will provide information and updates on this topic as they become available.
First, let’s review briefly Angiotensin receptor blockers (ARBs) and ACE inhibitors. ARBs are similar to ACE inhibitors, and they are usually used as an alternative drug. ARBs may be prescribed to avoid haking cough or angioedema that may be seen with ACE inhibitors. I am no expert on this topic, but I have read several experts‘ work regarding these two medications and COVID-19.
How ACE Inhibitors Work
Next, let’s review how ACE inhibitors work in the body. The video below gives you a nice summary of how ACE inhibitors work in the body.
(This is an affiliate link that supports the channel if you make a purchase. Thanks in advance for your support!)
ACEs & ARBs
From what I have read, as of March 2020, no one knows if ACE inhibitors or ARBs cause severe COVID-19. Nevertheless, much is being said in the literature and on the internet about this. In this post, I will share several conflicting views and including recommendations from the experts.
Let me be clear, this blog consists of health information only and not medical advice. Consult your doctor or health care professional for medical advice and any concerns you may have about your health.
Do not stop your medication unless instructed by your doctor or health care provider. Stopping your medication could cause dangerous spikes in your blood pressure or remodeling of your heart. Spikes and remodeling could result in a stroke, heart attack, heart failure, blindness, or other poor outcomes.
How Does COVID-19 Get into Your Body Cells
The Center for disease control has lots of reliable information on the website that will give you details about the transmission of COVID-19. Go to this link
Essential, COVID-19 uses the ACE2 enzyme to get into your body cells. If you take an ace inhibitor like Lisinopril or other medication that ends in “PRIL,” your body likely produces increased amounts of ACE2. An increased amount of this enzyme causes an increased amount of COVID-19 to get into your body cells increasing the severity of your illness. Likewise, a deceased amount of ACE2 would likely result in a mild case of COVID-19 if you become infected with the virus.
Yet, there are other studies that have shown that ACE2 is beneficial to decrease the amount of lung damage from pneumonia once the infection is inside your cells. This is very confusing, and researchers conducting large robust clinical trials over an adequate amount of time will have to sort this out.
Perhaps the ACE inhibitors or angiotensin receptor blockers may beneficial based on major risk factors, such as age, gender, or other physical characteristics (phenotypes).
Nevertheless, research has shown that less than 5% of people who are infected will have a severe illness involving difficulty breathing and the need for respiratory support.
What are Ace Inhibitors and Their Relationship to COVID-19?
In the video below (“COVID-19 and ACE inhibitors.”), Dr. Sanjay Gupta, a consultant cardiologist at Nuffield Hospital in York, describes what ace inhibitors are, what they are used for, and his understanding of their relationship to COVID-19 (“COVID-19 and ACE inhibitors.”).
Dr. Gupta says that there is a limited amount of research available on this topic. However, 30-50% of the people who died from COVID-19 in China had a much higher prevalence of high blood pressure. Nevertheless, there are too many other risk factors that may be equally responsible for contributing to increased deaths from the virus.
So far, researchers do not believe that high blood pressure, cardiovascular disease, nor diabetes are primarily causing an increased risk of severe COVID-19. More reliable studies are needed before any conclusion can be made.
Current Knowledge About Hypertension and COVID-19
Take a look at the video below (“Why Does High Blood Pressure Increase Risk From COVID-19.”), where Dr. Gupta explains what we currently know about high blood pressure and COVID-19 (“Why Does High Blood Pressure Increase Risk From COVID-19.”).
What Are the Recommendations From the Literature Regarding Ace-inhibitors and COVID-19?
Fang and colleagues (2020) gave specific recommendations in their paper published in The Lancet on March 11, a highly respected research journal.
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 ARBs. Based on a PubMed search on
Feb 28, 2020, we did not find any evidence to suggest that antihypertensive
calcium channel blockers increased ACE2 expression or activity, therefore
these could be a suitable alternative treatment in these patients. (p. 1)
Editorial
An editorial published in the British Medical Journal by Dr.David Moskowitz revealed that previously he postulated that ACE inhibitors and angiotensin II receptor blockers could generally be used as viral antidotes.
His postulate was based in part on the knowledge that ACE and ACE2 have the same binding site, and ACE 2 could not be duplicated, and angiotensin II receptor blockers seemed to reduce symptoms of the West Nile virus encephalitis in an unpublished study.
Dr. Moskowitz is conducting a study called the Master Viral Antidote trial. Between March 17 and today, he tweeted comments and several recommendations about ACE inhibitors and angiotensin II receptor blockers seen below (@dwmoskowitz, 2020).
Chloroquine is toxic. Hydroxychloroquine (HC) is less toxic, and was used in a COVID19 trial based in Marseilles. 26 ppl took it, 16 didn't. HC cleared the virus, but the only 5 people who died (1), went to the ICU (3) or quit bec of nausea (1) were taking HC. 1 HC pt ran away.
— dwmoskowitz (@dwmoskowitz) March 19, 2020
Expert Tweets
Mar 17
“Patient #1 of our #masterviralantidote trial: MS, 47 yr old, FL, given #ARB for common cold (most likely diagnosis). Result: back to normal the next morning” (@dwmoskowitz,2020).
Mar 21
“Just got off the phone w/ Dr Reza Nejat. He used tiny doses of losartan to cure ppl of COVID19 ARDS: 6.25 mg twice a day. 12.5 mg/day is the dose I use for babies. He used it for full-grown adults. So losartan is clearly some kind of wonder-drug” (@dwmoskowitz, 2020).
Mar 22
“Latest thoughts:
1. Prevent getting sick w/an ARB or ACEI, especially if you’re already on one.
2. If you do get sick because this virus overwhelms your innate immune response + your lungs, consider switching to ramipril.
3. Combining losartan and ramipril might make sense” (@dwmoskowitz, 2020).
Mar 22
“COVID19 patient #1 in my clinical trial just agreed to try losartan. He got symptoms despite benazepril, an ACE inhibitor” (@dwmoskowitz, 2020).
You can follow Dr. Moskowitz on Twitter for updates.
What Should You Do Now If You Are Taking an ACE Inhibitor or Angiotensin II Receptor Blocker?
Again, do not stop your medication unless instructed by your doctor or health care provider. Stopping your medication could cause dangerous spikes in your blood pressure or remodeling of your heart. Spikes and remodeling could result in a stroke, heart attack, heart failure, blindness, or other poor outcomes.
The American College of Cardiology (ACC), American Heart Association (AHA), and the Heart Failure Society of America (HFSA) recommend patients continue their ACE inhibitor or angiotensin II receptor blocker the continuation of ACE inhibitors and angiotensin II receptor blockers for anyone already on the medication unless stopped or changed by their health care provider (American Heart Association [AHA]).
Heart disease patients who have COVID-19 will be fully evaluated by an interdisciplinary health team and the most current scientific evidence will be considered before starting or stopping these medications.
Recommendations
Call your doctor or health care provider and ask if a calcium channel blocker or other medication would be appropriate for you if you are concerned. Your prescription may be changed and sent to your pharmacy without a visit to the doctor’s office. Telehealth may be available in your health clinic for a sort of Face Time visit.
Keep in mind that you may need to monitor your blood pressure more frequently whenever your medication is changed. See the link to purchase the most accurate blood pressure monitor for less than 35 dollars
Further, it is important to keep your blood pressure controlled to prevent any cardiovascular disease and to decrease your risk of severe COVID-19 symptoms. See Dr. Gupta’s video where he talks about why high blood pressure increase risk for COVID-19.
Conclusion
In addition, to treatment for high blood pressure, Ace Inhibitors and angiotensin II receptor blockers are protective for your kidneys. Optimal blood pressure and blood sugar control would offer similar protection, especially when your health care provider is considering alternative medications. Monitor and track your blood pressure and blood sugar and notify your health care provider for optimal control.
In summary, more research is being done to determine the role, if any, of ACE Inhibitors or angiotensin II receptor blockers and the severity of COVID-19 symptoms. Meanwhile, call your doctor or health care professional for medical advice and with your concerns. Generally, most people will be fine on their Ace inhibitors (i.e., Lisinopril) or angiotensin II blocker (i.e., Losartan) when it comes to COVID-19. Patients with heart disease, diabetes, or kidney dysfunction will be carefully assessed and monitored and evidence-based medicine will be considered on a case-by-case basis.
Updated on 04/16/2020
See below for the latest video on Lisinopril and COVID-19. Go to YouTube and cut and paste the title below in the YouTube search box to view.
1) What is your risk of COVID 19 with ACE Inhibitors or ARB? – Dr. Boon Lim
Dr. Boom Lim says that the evidence is still unclear. (posted 3/31/2020)
2) Angiotensin-Converting Enzyme 2 and Anti-Hypertensives in COVID-19
Dr. Carl Lavie is with the John Ochsner Heart and Vascular Institute in New Orleans (posted on 3/30/2010)
3) Study shows a possible link between blood pressure meds and severe cases of COVID-19 by WGN9 (posted on 3/25/2020)
Updated 05/2020
Sriram and colleagues’ research findings support the evidence that ARBs and ACE inhibitors do not put you at higher risk of COVID-19 and continued treatment is recommended.
Updated 07/2020
Currently, Flacco and colleagues’ summary of 10 high-quality studies and scientific societies recommend that patients continue ARBs and ACE inhibitors unless otherwise instructed by their health care provider.
Updated 12/2020
There is a study pending to be published soon that suggests that ACE and ARBs are protective in COVID-19. I will post the results as soon as it is published.
Resources
American Heart Association (AHA). (2020). Patients taking ACE-I and ARBs who contract COVID-19 should continue treatment unless otherwise advised by their physician. Retrieved from https://newsroom.heart.org/news/patients-taking-ace-i-and-arbs-who-contract-covid-19-should-continue-treatment-unless-otherwise-advised-by-their-physician
Best Home Blood Pressure Monitor to Monitor and Track Your Blood Pressure
Supporting Resources
Gupta, Sanjay. “COVID-19 and ace inhibitors.” Online video clip. York Cardiology. YouTube, 22 Mar. 2020. Web. 24 Mar. 2020.
Gupta, Sanjay. “Why Does High Blood Pressure Increase Risk From COVID-19.” Online video clip. York Cardiology. YouTube, 24 Mar. 2020. Web. 24 Mar. 2020.
Moskowitz, D. (2020). Regarding: China coronavirus: mild but infectious cases may make it hard to control outbreak, report warns. Retrieved from https://www.bmj.com/content/368/bmj.m325/rr. doi: https://doi.org/10.1136/bmj.m325
@dwmoskowitz. (2020, March 17). Patient #1 of our #masterviralantidote trial: MS, 47 yr old, FL, given #ARB for common cold (most likely diagnosis). Result: back to normal the next morning [Twitter post]. Retrieved from https://twitter.com/dwmoskowitz
@dwmoskowitz. (2020, March 21). Just got off the phone w/ Dr Reza Nejat. He used tiny doses of losartan to cure ppl of COVID19 ARDS: 6.25 mg twice a day. 12.5 mg/day is the dose I use for babies. He used it for full grown adults. So losartan is clearly some kind of wonder-drug [Twitter post]. Retrieved from https://twitter.com/dwmoskowitz
@dwmoskowitz. (2020, March 22). Latest thoughts:
1. Prevent getting sick w/an ARB or ACEI, especially if you’re already on one.
2. If you do get sick because this virus overwhelms your innate immune response + your lungs, consider switching to ramipril.
3. Combining losartan and ramipril might make sense [Twitter post]. Retrieved from https://twitter.com/dwmoskowitz
@dwmoskowitz. (2020, March 22). COVID19 patient #1 in my clinical trial just agreed to try losartan. He got symptoms despite benazepril, an ACE inhibitor [Twitter post]. Retrieved from https://twitter.com/dwmoskowitz
Latest Resources
Flacco ME, Acuti Martellucci C, Bravi F, et al. Treatment with ACE inhibitors or ARBs and risk of severe/lethal COVID-19: a meta-analysis. Heart. 2020;106(19):1519-1524. doi:10.1136/heartjnl-2020-317336
Sriram, K., & Insel, P. A. (2020). Risks of ACE Inhibitor and ARB Usage in COVID-19: Evaluating the Evidence. Clinical pharmacology and therapeutics, 108(2), 236–241. https://doi.org/10.1002/cpt.1863
[podcast_subscribe id=”4188″]
This Website was created with Bluehost. Click here to create your website.
Disclaimer: I include affiliate links when possible. If you purchase from the link, I will earn a small commission at no cost to you. Thanks in advance for your support!
Thank you for that info. Are there any other downsides from taking an ACE inhibitor?