Given the recent publication in the Lancet medical journal which questions whether the severity of COVID-19 is greater in patients taking ACE inhibitors, please as a matter of urgency could the BHF obtain empirical data from China or Italy to determine whether this is the case. The NNT for ACE inhibitors in secondary prevention is high (1:100 over 5 years) and thus the risk associated with drug discontinuation may be less than the risk asociated with contracting COVID-19. Similar concerns could also be raised over the use of statins, with some studies suggesting that these might decrease disease severity (through reducing inflammation in the lung), whereas others suggest that statins might reduce the anti-viral interferon response and thus increase the severity of the disease. I do not feel that "keep on taking the medication" is an acceptable stance given that guidance could be based on data from other countries where there are far more COVID-19 cases.
Reference: Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet, March 11th 2020.
One thing I do know for certain is I have Heart Disease and Currently I think I don't have Corona Virus. So would your advice be to continue with the Heart Meds or just let them Go !!!
This is from a letter to be published in the American Journal of Physiology......."Furthermore, preliminary available data from infected patients illustrate that patients treated with angiotensin-II inhibitors (ACE-I)/angiotensin receptor blockers (ARBs) or non-steroidal anti-inflammatory drugs (NSAIDs) exhibit severe symptoms with a higher mortality rate as compared to non-user counterparts. See: journals.physiology.org/doi...
Hi yes my gp rang me and said this may not be correct. He did send me another study. And that said you must keep on taking the drugs. My gp thinks ace inhibitors offer more protection. He told me to stop reading stuff as well 😂
Interesting that you mention this. I stumbled across this same "Lancet" article yesterday and have been pondering over the implications ever since. For anyone wanting to read the original text, here's a link,
It's important to remember that this is currently only a hypothesis, as the article itself clearly states,
"We therefore hypothesise that diabetes and hypertension treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19."
Consequently I doubt we'll get more than shrugged shoulders from our GP's or cardiologists as this hypothesis is still months or years away from being proven or accepted.
On the other hand the explanation given within the article seems entirely plausible, and "The Lancet" is one of the most respected publications on the planet, so hypothesis or not this is still an idea that demands respectful consideration. The ravings of some internet crank, this is certainly not!
After chewing this over here's my personal plan. I should emphasise that I am not a doctor and in no way am I recommending this as appropriate for anyone else. But during these extraordinary times we are all responsible for taking our own decisions, for the sake of prompting debate here are mine.
My blood pressure is now very well controlled, well within even the most stringent safety measures. Consequently I think the door is open for me to temporarily suspend taking Ramipril, the ACE Inhibitor that I am prescribed.
However, I'll also be taking three other steps,
1. Daily measurement of my blood pressure using a good quality and calibrated device. I plan on tracking the trend and if my blood pressure increases then I'll revisit my decision.
2. Double down on the non-medication steps I've already been successfully practising to reduce my blood pressure. Namely, well over 150 minutes of aerobic exercise each week, reduce caffeine intake, keep my weight down within BMI height/waist ratio guidelines, reduce my salt intake, strictly limit alcohol, avoid packaged or processed foods with their notoriously high salt content, eat a balanced Mediterranean diet, and practise mindfulness and stress management. Other things not relevant to me but possibly relevant to others would include stopping smoking/vaping/nicotine intake and avoiding any ibuprofen based pain killers.
3. Discuss with my GP switching from Ramipril to a calcium channel blocker, driven by this comment from "The Lancet" article,
"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".
Incidentally, there is another very recent article in "The Lancet" which is attracting a lot of praise around the world for being a particularly insightful summary of Covid-19. If anyone's interested here's a link,
I’m wondering in forming the research question whether they looked at the medication the departed where taking. I am concerned because I take ramipril.
I'm pretty sure the answer to your question is "no".
Basically they look at how corona virus works, and they look at how ACE Inhibitors (such as Ramipril) work, and they say look, here's a clear mechanism whereby Ramipril might be exacerbating the potentially fatal effects of the virus.
It's interesting that other data I've seen indicates that the number one risk factor for fatal corona virus infection is high blood pressure. What this article is suggesting is that it's maybe not just high blood pressure on its own that's the risk, it's perhaps the medication that an awful lot of high blood pressure sufferers are taking.
The high blood pressure question first came up when doctors in China were analysing fatalities in China and reported that a large number of people who had died had high blood pressure.
When you look at data for BP in the population of China, over 50% of people between the age of 35 and 75 have high blood pressure, and only about a third of them are having any sort of medication/treatment for it.
So I imagine that in light of the percentage who have high BP the incidence of fatalities with high BP could be expected. Additionally as only a third of those with high BP are on any sort of medication, the link (at least in China) between BP medication and mortality could be weak.
I don't know - the article I read just said that there was an observation of the fatalities in China, that a large number had high blood pressure, as far as I'm aware, in that article there was no reference to heart disease
That's all well and good but I'm on ramipril and amlodipine so no use for me to think I could swap ramipril for a calcium channel blocker.😒 Better just hide myself away until this blows over!
Many thanks to those who responded - it would be interesting to compare mortality data from patients receiving either ACE-inhibitors or calcium channel blockers.
These articles are written by Experts for Experts to try to start to understand exactly what they are saying you need to be part of the Expert Team . Me I am happy to leave it to the experts.
I think GPs even don't have the knowledge to Advise on this.
Here's a link to what the European Society of Cardiology have to say on the subject - basically there is no evidence of a link so keep taking the meds! Hope this helps to reassure people
There's lots of data, but as it's a new virus the medics and science are trying to get their heads around it. They will, and with the technology at our disposal they shouldn't take that look to figure it all out, compared to how long it took in 1918 with Spanish Flu. And to go back further - the Black Death in 1347 which ravaged Asia and Europe was put down to "Bad Air" - thankfully we've come a long way since then!
I forgot to say - the Lancet article does not suggest people stop taking ACE inhibitors - it actually proposes switching to a different type of medication - calcium channel blocker - presumably this should not be a problem, and only reinforces the need for an evidence based solution. Once again many thanks.
I think the European Society of Cardiology has said not to stop because other media sources have picked up what the Lancet has published and sort of twisted it a bit and left a suggestion that people should consider not taking it
These are indeed very worrying times. For me, my peace of mind, I've flipped the statistics. Worse case scenario for those of us with cardiovascular disease is a morality rate of around 10%, that means we have a 90% chance of surviving covid-19 if we got infected. I'm doing all I can to avoid getting it but it may not be completely under my control so I find it helpful to focus on the 90% survival rate rather than the other way round 🙂. Just a thought.
Not dumb at all - I had the same question a few days ago. From what I read (Mayo Clinic, yes, a US site but credible and well written information there), the short answer is no - but I took that 'no' with a bit of a grain of salt. My take-away was ace inhibitors are not the same but beta blockers are used sometimes for BP concerns whilst being very good at controlling angina - but I'm not medically trained and could be mistaken in how I understood the information.
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