University HealthCare Alliance

July 20, 2020

High Blood Pressure Drugs Don’t Increase COVID-19 Risk, Stanford Study Finds

People taking two very commonly used types of drugs for high blood pressure are at no heightened risk, as has been feared, for complications of COVID-19.

So concludes a study in COVID-19 patients, directed by Stanford infectious-disease specialist Catherine Blish, MD, PhD. Results are published in the Journal of Clinical and Translational Science.

High blood pressure — suffered by at least 29% of people over 18 — is bad enough by itself. So is COVID-19. When the two collide, it’s a double whammy. In addition to the known higher likelihood of heart attack and other health threats, high blood pressure also confers as much as a 2.5-fold higher risk of severe or fatal COVID-19 than normal blood pressure does, especially in older individuals.

The two types of drugs that have been of concern to medical practitioners and public health officials are angiotensin-converting enzyme inhibitors, or ACE-Is, and angiotensin-receptor blockers, or ARBs.

Drugs that block blood-vessel constriction

These medications are widely used: In the United States, of everyone 20 or older, an estimated 12% are on ACE-Is and 5.8% are on ARBs, according to 2012 data from the American Heart Association. That’s a lot of people — and, if anything, the percentage of individuals using these drugs has increased since then.

Both kinds of drugs work by blocking the blood-vessel-constricting action of angiotensin, an enzyme secreted by the kidneys. They also, among other things, cause an increase in cells’ production of ACE2, a molecule with blood-pressure-lowering properties that appears on the surface of cells in the throat, lungs, arteries, heart, kidney, intestines and blood-vessel linings.

So far, so good.

The problem is, ACE2 just happens to be precisely the molecule that SARS-CoV-2 — the virus responsible for COVID-19 — grabs onto in order to gain entry into the cells it infects. Only cells bearing ACE2 are prone to SARS-CoV-2 infection; so the fear has been that by increasing the density/number of ACE2 molecules on cells’ surfaces, ACE-Is and ARBs may be making those cells better targets for SARS-CoV-2.

You can see why medical authorities would worry about whether these drugs might place their users at heightened risk for coronavirus infection and more-severe cases of COVID-19.

Use not associated with severe COVID-19

Happily, the Stanford study, which analyzed medical records of just over 1,000 patients, found otherwise. Use of ACE-I or ARB medications by COVID-19 patients was not associated with increased risk of hospitalization, intensive care unit admission or death.

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