‘To take or not to take…that is the question’: ACE inhibitors/ARBs and COVID-19 Pandemic

Welcome to the inaugural blog post for COR Healthcare Associates!  We are incredibly grateful and honored to be able to serve the Los Angeles South Bay and hope that this blog will be a useful platform to share and elaborate on important topics.  Now…without further adieu, let’s jump into it!

A very common question from patients…and from the medical community at large for that matter…relates to the use of ACE inhibitors (generally drugs that end in …pril such as lisinopril) and ARBs (generally drugs that end in …artan such as losartan) with respect to the COVID-19 pandemic.  Let me be the first to say that we are ALL learning right now.  SARS-CoV 2 (the virus causing the disease dubbed COVID-19) is a “novel” coronavirus for a reason.  While it shares a number of similarities of SARS-CoV 1 (the virus that caused the initial SARS epidemic in the early 2000s), there are also some key differences in addition to a lot of information that we still don’t know about SARS-CoV in general. 

BUT…here’s what we do know.  Think of SARS-CoV2 as a tennis ball with a bunch of spikes on it’s surface (the spike or S proteins that Dr. Fauci has been talking about).  These spikes bind to ACE2 (a protein enzyme that is on the surface of your lungs, blood vessels, heart, GI tract, kidneys, etc) to facilitate entry and infection, much like a key fits into your front door lock to gain entry into your home.  So…why do we care about ACE inhibitors and ARBs?  This is because these very commonly used drugs that are used for hypertension, heart failure, kidney disease, diabetes, etc, increase the amount of ACE2 on the surface of your cells.  Thus…theoretically…there may be more ACE2 around for the virus to bind to and lead to infection.  However, as mentioned, you already have a lot of ACE2 on your cells…so any risk at this time is still theoretical and NOT proven (but stay tuned as I’ve said…we’re learning at an incredibly changing rate these days). 

Now…what is the flip side of ACE2 and ACE inhibitors/ARBs???  Well…ACE2 is actually a VERY important enzyme to reduce inflammation and a number of other harmful reactions in the body.  That is at least the thought as to why ACE inhibitors and ARBs have such beneficial effects beyond just lowering your blood pressure.  The ACE inhibitors and ARBs increase the ACE2 levels that overall help you.  This is also the leading hypothesis as to why SARS-CoV 2 causes your body to REDUCE the ACE2 level on the surface of your cells…to hinder your body’s ability to regulate inflammation, which has been a major factor in individual’s who have suffered from severe complications of the disease. 

So…what do I do???  Well the recommendation by the leading societies such as the American Heart Association, American College of Cardiology, and others, is to stay on your current ACE inhibitor or ARB.  But won’t I be at increased risk of infection???  Again, the risk mentioned earlier is only theoretical at this point AND also theoretically taking these medications MAY help with the infection by allowing you to keep more ACE2 around to fight unruly inflammation.  In fact…there are a couple of trials being started specifically looking at giving patients with COVID-19 an ARB drug to see if it helps.  However, this is only a study and by no means is it an endorsed treatment at this time.  That’s why the recommendation from the aforementioned societies, is to stay on your medication if you have a reason to be on one BUT not to start one if you otherwise don’t. Bottom Line: Continue taking your ACE inhibitors/ARBs.

Well…that’s it for now.  We hope that this been helpful to understanding a little more about this topic and we look forward to sharing more information on this blog in the near future.

Be well,

B

Brenton Bauer, MD, FACC

Author

Brenton Bauer Brenton Bauer, MD, is an an award-winning physician board-certified internist and cardiologist at COR Healthcare in Los Angeles. He sees patients at the Torrance and Redondo Beach offices in addition to the cardiology department at Torrance Memorial Medical Center. He specializes in general cardiology, cardio-oncology, and advanced cardiac imaging. Dr. Bauer completed his medical education and advanced training at the University of California, Los Angeles (UCLA). In addition to earning his Doctor of Medicine with honors, Dr. Bauer completed an internal medicine internship and residency, serving as chief resident, and a cardiovascular disease fellowship serving as chief fellow. He has been certified by the American Board of Internal Medicine in addition to subspecialty boards of Echocardiography, Cardiovascular CT, and Nuclear Cardiology. Dr. Bauer has written extensively for medical journals and other publications.