Posted on 04/10/2020 5:53:56 AM PDT by tired&retired
ACE Inhibitors and ARBs During the COVID-19 Pandemic
Allan S. Brett, MD and David M. Rind, MD reviewing Patel AB and Verma A. JAMA 2020 Mar 24 Gurwitz D. Drug Dev Res 2020 Mar 4 American College of Cardiology. 2020 Mar 17
How should clinicians navigate clinical uncertainty for patients who are taking angiotensin-converting–enzyme inhibitors or angiotensin-receptor blockers?
Many patients and clinicians are aware of the recently publicized interplay between SARS-CoV-2, the coronavirus responsible for COVID-19 illness, and the renin-angiotensin system. Patients concerned about susceptibility to coronavirus already have asked whether to continue taking their prescribed angiotensin-converting–enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs), and patients who test positive for the virus likely will have the same concern.
The problem is as follows: Experts have postulated both potentially harmful and potentially beneficial effects of these drugs on the natural history of COVID-19.1,2 Membrane-bound angiotensin-converting enzyme 2 (ACE2) participates in the entry of SARS-CoV-2 into human cells, and animal studies show that ACE inhibitors and ARBs upregulate ACE2 expression. In theory, this effect could increase risk for or severity of COVID-19. Conversely, some researchers speculate that ACE inhibitors and ARBs could benefit patients with COVID-19 through various mechanisms. For example, ACE2 converts angiotensin II to angiotensin-(1–7), which has potentially beneficial vasodilatory and anti-inflammatory properties; upregulating ACE2 (with ACE inhibitors or ARBs) could enhance this process. Observational studies have not yielded compelling data on whether COVID-19 patients who take these drugs fare better or worse than otherwise similar patients.
https://www.jwatch.org/na51345/2020/04/09/ace-inhibitors-and-arbs-during-covid-19-pandemic
Decision-making under uncertainty is necessarily stressful, both in medicine and more generally. Some people become immobilized by true equipoise around available options. A sensible position for overworked and stressed clinicians facing a global pandemic is to recognize that, for now, the effect of ACE inhibitors and ARBs on the natural history of COVID-19 is unknown. Clinicians should attempt to make decisions that will minimize future regret for themselves and for their patients if the decision eventually is proven “wrong.”
Isn’t the thinking to consider switching patients from ACE inhibitors (“pril”) to ARBs (“tan”)?
interesting yes. However the renin angiotensin system may be upregulated in essential hypertension anyway even without meds. Would be interesting to see. But don’t stop your medications!
so far there is no evidence that helps. Guidance from the university of washington and others says no need to switch. It would make sense changes in receptors takes a good deal of time and changing meds would likely make no difference acutely
informative maybe. Accurate - lets just say there is a lot of bad info here as well as some good stuff
We are in a bad spiral: “shelter in place” order —> sedentary —> higher BMI —> more COVID deaths —> extend “shelter in place” order —> higher BMI —> etc
Darker skinned people have a harder time turning sunshine into Vit D. Lower Vit D is seen in high blood pressure. Perhaps this is linked to the higher number of Blacks getting CV and having more problems with it than lighter skinned persons.
Also ace and arbs act in essentially the same fashion so I would expect. it’s would upregulate the Ace receptors. I work in covid units in the hospital and I haven’t stopped my Ace inhibitor.
That is a weird story. Those malaria drugs may just have saved your bacon?
Same - listening to the Left takes my BP from 125/68 to 150/85 in a heartbeat sometimes...
“It’s like pulling teeth to get these ‘experts’ to come out of their normalcy bias.”
No chit. Agreed.
I’ve known since February about the ACE2 factor and everything in this article was easily-deduced AT THAT TIME. Now the knowledge ought to be clinical, but we all know the reality.
The incredible obstinance of these people angers me immensely when there are obviously smarter people out there than Birx/Fauci who could be counseling the president with pertinent policy advice rather than the current destruction being wrought on the basis of their ongoing usurpation.
Your transient respiratory symptoms while traveling in SE Asia could have been due entirely to mold exposure. Extremely common, especially when traveling in areas of high humidity (river trip) where mold is prevalent. If you were traveling by air prior to arrival, the transient low humidity on board the aircraft can temporarily dry out your respiratory system which then increases your sensitivity to mold spores once you are out of the airplane. It is very common to fly into a city with a moist climate and within minutes after leaving the airplane, a persistent cough and respiratory reaction occurs that doesn’t go away until you return home. You don’t mention any symptoms that are indicative of a viral infection.
> “I heard Dr. Oz on Fox News state that the virus enters the cell through the same channel as the blood pressure medicine. i.e the ACE2 receptors.”
The above is true.
> “”But due to heading into remote Thailand and Laos by extensive travel on the Mekong River, I started taking anti malaria medication for the next 5 weeks of travel.
Let’s assume you picked up the SARS-COV-2 virus.
Chloroquine and quinine derived analogs lock the SARS-COV-2 out by blocking the ACE2 receptor.
The recovery without Zinc was due either to young age having a strong immune system, or a Zinc rich diet, or catching it before it had a chance to develop into full blown COVID-19 with ARDS coupled with the a relatively strong immune system and/or Zinc-rich diet.
As you call yourself ‘retired’ perhaps your recovery was not due to young age with a robust immune system. But as far as immune systems go, an age of 60 or less is considered a young immune system.
You seemed to have taken a chloroquine medicine fairly quickly after the symptoms worsened so I think you caught it before it took you out. Congrats.
But chloroquine by itself won’t do it. Because you write that you got it, then it went away, it sounds like your immune system is strong. Then you it started seeing worse symptoms and by grace of God you took some variety of chloroquine treatment to bring reinforcements in the battle to take the virus out. But it could also be your diet helped in the battle.
If you eat a lot of seafood (oysters, crab, shrimp, salmon), liver, wild fowl giblets, and drink organic red wines (from France, some vineyards in Napa, some in Eastern WA State), whole grains like wild rice, then chances are your blood plasma has above average zinc content.
American diet should be rich in Zinc in its large amounts of red meat and poultry but unfortunately Zinc and other minerals and nutrients are lacking because of processing. Might be a good thought to push for Zinc fortified foods after this pandemic experience.
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I’ve often said that someone upstairs looks out for me. My life has been one wonderful bizarre coincidence after another, in spite of me.
Just prior to leaving for Southeast Asia in January I had many vaccinations... including all the flue shots, Japanese Encephalitis, Influenza, Typhoid ....... Because of this, I spent a month reading and studying all the different viruses using the Baltimore classification system. They intrigued me.
My travel adviser at the university was a pharmacist in the international travel department who is certified in disease prevention. Thus, I had a cram course in Asian diseases. Who knows what was going on in my body with about a dozen vaccinations.
I had no idea when I began taking the anti malaria medication prophylacticaly that it was protecting me from anything other than malaria.
The next bizarre thing was craving while traveling was for tonic water or quinine water. While home I love it occasionally with a bit of gin and Roses Lime Juice, but for 6 weeks I drank tonic water daily as it appeared to make me feel better. Probably the sugar as I rarely drink soda.
I was on an antibiotic as I took a bottle along in case I got traveler’s diarrhea. No problem there, but had a tooth bothering me so I started taking that about 2 weeks into the 6 week trip to resolve an abscess problem.
Long plane rides usually cause me to get a sore throat, and this one was over 20 hours, so I took along two bags of Nature’s Way Sambucus Elderberry Zinc Lozenges. I went through the both bags during the travel.
The air pollution in Bangkok was so bad in mid January that school was cancelled several days while I was there. Everyone wore masks due to the pollution, not fear of the virus.
When I look back, I couldn’t have planned it better had I known about the corona virus about to hit.
“There is absolutely no evidence that anyone should stop their blood pressure or heart failure medications thad include ace inhibitors or ace receptor blockers but doing so could put your health in immediate jeopardy. Do not stop medication without at least talking to your physician.”
There are alternatives that lower the blood pressure using different chemical processes than employed by either ace inhibitors or beta blockers.
Yes there are. What does that have to do with not stopping high blood pressure or heart failure medication without talking to your physician?
They go together. You can press your doctor about why, above all other considerations, they prescribed the one they prescribed and aren’t they equally effective alternatives. Too many people treat doctors as gods and don’t ask enough questions. Many assume too much about why a particular medicine is prescribed when there are others available, yet often many medicines are prescribed just because they are known to “work” and for little other consideration.
actually i put quite a bit of thought into which blood pressure medications i prescribe but thank you
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