Should I stop my ACE inhibitor or ARB- 'Sartan'- Medication to reduce the risk of the coronavirus affecting me?
There has been a lot of public and medical concern with the possible increased severity of COVID-19 if you are taking an ACE inhibitor or Angiotensin II Receptor Blocker(ARB) medication, but there are also some doctors who believe they could be beneficial at this time.
These are medications are commonly used to treat :
High blood pressure,
Kidney disease (to protect your kidneys),
Heart attack ( by preventing further rupture of the plaques in narrowed arteries),
heart failure.
At present the Medical advice is to stay on your medication.
Numerous medical organisations from Euorpean society of cardiology to the UK renal association are recommending that GP’s do not switch their patients at this time.
But, If you become unwell with a fever or persistent cough and you are well enough to stay at home, you MUST speak to your GP about ‘withholding’ you ACE inhibitor or ARBII or other ‘water tablet’. This is because you are at risk of dehydration when taking a water tablet (diuretic, ACE inhibitor or ARBII/Sarten) which can make you more sick.
Your GP may tell you to stop your ACE inhibitor, ARBII or water tablet for 3-5 days if you are having diarrhoea. But always speak to your doctor before withholding medication.
In some cases you may need a blood test to check your your kidneys are working as before.
So What is the concern about taking ACE inhibitors or ARB’s?
It was noted that a lot of patients who became more severely affected by the COVID-19 virus had high blood pressure. This was thought to be strange as people with high blood pressure are not usually at increased risk of other infections, unlike someone who has diabetes or a lowered immune system.
So, doctors in China and Australia looked into the mechanism by which the virus COVID-19 enters the lung cells and found that it gets in by hitching a ride with ACEII, an enzyme found in our blood.
Some studies have shown that Angiotensin II receptor blockers (ARB’s) such as the drugs ending in ‘Sartan’, increase the amount of ACEII in the blood, which could mean the virus has more pathways into the lung cells by attaching on to more ACEII.
Paradoxically, animal studies have shown that giving ACE II to mice with a similar viral infection reduced lung damage. There are many other laboratory studies- not in large groups of humans- that support the use the ACE II to reduce lung and heart damage; but this does not address possibly having higher ACE II levels to begin with.
As for ACE inhibitors, there is debate whether or not they could actually increase the levels of ACEII in humans as this has only been found to be the case in animal studies so far.
Also, not all ACE inhibitors are equal in their affects, so we may learn more about them in relation to viral infections as these months unfold.
Likewise, not all humans respond in the same way to the same medication, depending on how certain people ‘process’ a medication.
To summarise, having more ACEII in your blood could possibly be beneficial, meaning that being on an ARB could have positive effects while having the COVID-19 virus, although we cannot be sure of this at this stage.
To help shed some light on this conundrum there is a trial, soon underway, looking at the ARB, Losartan as a treatment for Covid-19 in patients both in and out of hospital.
You can read about these trials here: (NCT04312009. opens in new tab) (NCT04311177. opens in new tab).
You can also read the original publication on this hypothesis by Professor Murray Esler, consultant cardiologist at the Alfred Hospital Melbourne, Australia here, who flagged the initial concern over ACE inhibitors and ARB’s
The NEJM have a useful, but complexly dense article on both ACE inhibitors and ARBs in relation COVID-19 and they go into detail on the hypothesis that ARBs could be beneficial if you were to develop COVID-19.
But for now, the general opinion of medical experts in all fields is to keep your patients on their ACE inhibitors and ARB’s if they remain well.
Like everything, this may change if any new medical information comes to light over the coming weeks and months, so keep an open mind.
Also, as mentioned above, each person is different and if the anxiety of being on an ACE inhibitor for high blood pressure is causing you more distress it is useful to discuss your options with your GP.
What can I do to reduce the risk of Infection?
Wash your hands regularly
Wash your hands before eating and after going to the toilet
Cough into your elbow, or tissue then bin-it.
Stay away from those who have symptoms
Avoid seeing children when the infections rates high i.e. now.
Air your house daily.
Do not shake your cloths into the air
Clean the surfaces in your house regularly
Iron or tumble dry your clothes
Where a cotton mask or scarf to protect others from you when you are out in a supermarket. ( you may be carrying the Coronavirus and not know it!)
Drink enough water so that your urine is clear- this is very important
Take Vitamin D3 800 iu a day
Take vitamin C 1000mg once a day for the next 8 weeks
Take Zinc 25mg once a day for the next 8 weeks during ‘flu season’.
Eat well- avoid refined sugars ( food with sugar, white bread, buns and cakes)
Eat fresh vegetables, herbs, nuts, seeds, and some fruit each day, if possible
Eat protein and fat from eggs, beans, lentils, chickpeas, chicken, fish or meat. ( these are just guidelines, you’ll know best what suits your body and beliefs; you may consider reducing your meat intake to once a month at this time and eat more beans, lentils, nuts, avocados and cheese.)
Get some Exercise each day
Talk to family and friends: share what you know about isolation rules
Think of something new to do or learn during any periods of isolation.
Keep up to date with Government’s Advice on what to do if you have symptoms of the flu. Click here.
Remember self-isolation is hard and boring, but it is a big part of the solution.