Keep taking the blood pressure medicine during the pandemic

Each day, at least half a million Danes take a small pill to keep their blood pressure down or to protect against heart disease, and they should continue to take the medicine during the pandemic – even if the pill they take is an ACE inhibitor or Angiotensin II receptor blocker such as Losartan, Enalapril or Ramipril.

This is underscored by a new reassuring study, which, unlike all previous studies, also includes all Danes who have been tested for corona over a five month period – and not 'just' the most ill patients who have been hospitalised.

The researcher behind the research result is Christian Fynbo Christiansen, who is consultant, clinical associate professor and PhD at the Department of Clinical Epidemiology, which is part of the Department of Clinical Medicine at Aarhus University and Aarhus University Hospital.

Same risk and course of illness

"The study finally removes any lingering suspicion that this particular type of blood pressure medicine increases the risk of getting corona or of suffering a worse illness, which was something that many health professionals feared while we were learning about corona. But there is no evidence to conclude such fears are correct," says Christian Fynbo Christiansen.

In the study, which includes all Danes who were tested in the period from 27 February to 26 July this year, the researchers have examined whether users of the popular blood pressure medications had an increased probability of a positive corona test, and whether the outcome of any illness was different than that of users of other types of blood pressure medication. The comparison group also includes people who do not take blood pressure medication.

"The study shows that people who take ACE inhibitors and Angiotensin II receptor blockers had the same probability of a positive test – and no increased risk of being hospitalised or dying," says Christian Fynbo Christiansen, who can thus confirm in a large-scale study what other smaller studies have already hinted at.

Under suspicion – but acquitted

The new study is published in the journal Thorax and is part of a discussion about treatment that peaked in the early summer, when the coronavirus was still a new acquaintance. At the time, medical doctors and researchers feared that ACE inhibitors could actually increase the risk of dying from COVID-19, because the SARS-CoV-2 virus which causes COVID-19 enters the lungs through the same ACE receptors as the ACE inhibitors.

The hypothesis was that when the ACE inhibitor does what its name states and reduces the level of ACE, the body compensates for this by activating a far greater number of ACE receptors on the surface of the cells, which the SARS-CoV-2 virus then utilises as a kind of access key. The more keys available on the surface of the cells, the easier it is for the virus to access the cells.

"The theory about increased mortality was nourished by the fact that many of the severely ill COVID-19 patients had elevated blood pressure, which is widely treated with these ACE inhibitors. This is also why it was important to include all the Danes who had been tested – and not just those who were hospitalised – in the study," says Christian Fynbo Christiansen.

"We have a qualified basis to reiterate the current recommendation that users of medicines of the type ACE inhibitors and Angiotensin II blockers should continue to take their medicine while the pandemic is raging," he says.

Facts about ACE inhibitors and Angiotensin II receptor blockers

ACE inhibitors are a group of drugs which expand the blood vessels so that blood pressure is lowered and the work of the heart becomes easier. An ACE inhibitor dampens the enzyme in the body which ensures that the inactive angiotensin I is converted into the active angiotensin II. Angiotensin II causes contraction of the blood vessels. When the body forms less angiotensin II, the blood vessels relax and blood pressure decreases. The acronym ACE stands for Angiotensin Converting Enzyme. As the name suggests, angiotensin II blockers work directly on angiotensin II.

The research results – more information

• The study is a register-based study of the 1,102,196 Danes who were tested for the coronavirus in the period from 27 February to 26 July 2020. Of these, 13,501 tested positive during the period. In the study, data from the Danish Microbiology Database (MiBa) has been linked with the Danish Register of Medicinal Products, where information was retrieved on the use of medications to lower blood pressure. By linking with the Danish National Patient Register, the Danish Register of Causes of Death and the Civil Registration System, it was possible to study hospitalisation, intensive care hospitalisation and mortality.
• The study was conducted as part of the Danish COVID-19 cohort (DACCOVID) in collaboration with, among others, Professor Anton Pottegård from the University of Southern Denmark, Head of Section Marianne Voldstedlund from Statens Serum Institut (SSI), and Director of Division Nikolai Brun from the Danish Medicines Agency.
• The study has not received any external funding.
• The media coverage is based on the scientific article: SARS-CoV-2 infection and adverse outcomes in users of angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers: a nationwide case-control and cohort analysis, which is today published in the journal Thorax: http://dx.doi.org/10.1136/thoraxjnl-2020-215768   

Contact

Consultant, Clinical Associate, PhD Christian Fynbo Christiansen
Department of Clinical Epidemiology at
The Department of Clinical Medicine, Aarhus University
Aarhus University Hospital
Mobile: (+45) 2020 8398
Email: cfc@clin.au.dk