Blood-pressure drugs are in the crosshairs of COVID-19 research

[snoop1130]

Blood-pressure drugs are in the crosshairs of COVID-19 research

By Deborah J. Nelson

 

FILE PHOTO: A member of the French Civil Protection service measures blood pressure of a man suspected of being infected with the coronavirus disease (COVID-19), as its spread continues, in Paris, France, April 5, 2020. REUTERS/Benoit Tessier/File Photo

 

(Reuters) - Scientists are baffled by how the coronavirus attacks the body - killing many patients while barely affecting others.

 

But some are tantalized by a clue: A disproportionate number of patients hospitalized by COVID-19, the disease caused by the virus, have high blood pressure. Theories about why the condition makes them more vulnerable – and what patients should do about it – have sparked a fierce debate among scientists over the impact of widely prescribed blood-pressure drugs.

 

Researchers agree that the life-saving drugs affect the same pathways that the novel coronavirus takes to enter the lungs and heart. They differ on whether those drugs open the door to the virus or protect against it. Resolving that question has taken on new urgency after an April 8 report by the U.S. Centers for Disease Control and Prevention showed that 72% of hospitalized COVID-19 patients 65 or older had hypertension.

 

The drugs are known as ACE inhibitors and ARBs, broad categories that include Vasotec, Valsartan, Irbesartan, as well as their generic versions. In a recent interview with a medical journal, Anthony Fauci - the U.S. government’s top infectious disease expert - cited a report showing similarly high rates of hypertension among COVID-19 patients who died in Italy and suggested the medicines, rather than the underlying condition, may act as an accelerant for the virus.

 

Efforts to understand how the virus uses the pathway to the heart and lungs, and the role of the medicines, are complicated by a lack of rigorous studies.

 

“There are millions of Americans that take an ACE inhibitor or AR daily,” said Dr Caleb Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness in Baltimore. “This is one of the most important clinical questions.”

 

An estimated 100 million U.S. residents suffer from high blood pressure, which increases the risk of heart disease, stroke and kidney failure. About four-fifths of them need to take prescription drugs to control it, according to the CDC. ACE inhibitors and ARBs are widely prescribed to patients with congestive heart failure, diabetes or kidney disease. The drugs account for billions of dollars in prescription sales worldwide.

 

The absence of clear answers on how the drugs impact COVID-19 patients has sparked rampant speculation in correspondence and editorials posted on medical journal websites and those where scientists share unreviewed, pre-publication study drafts.

 

Many patients are agonizing over whether their medicines will help or hurt them. Doris Kertzner, 88, of Redding, Conn., said she has carefully followed experts’ guidelines for preventing infection and keeps her distance from others in her retirement community. Now she has a new worry: She takes losartan, an ARB, and can’t decide whether to stop.

 

Dropping the medicine “presents its own problems” in dealing with her high blood pressure.

 

“It’s gotten very complicated,” she said.

 

Dr Carlos M. Ferrario - a researcher at the Wake Forest University School of Medicine and co-author of widely cited studies on ACE inhibitors - understands patients’ plight.

 

“There is a lot of paranoia and a lot of speculation with very little fundamental, convincing information,” he said.

 

The National Institutes of Health in the United States has put out a call seeking proposals for studies into the issue. An independent consortium of researchers has launched a global study to analyze health records for thousands of COVID-19 patients in the United States, Europe and Asia. That project is part of the Observational Health Data Sciences and Informatics program, an open-source research platform that enables large-scale studies.

 

Dr Marc Suchard - a biostatistician at the University of California, Los Angeles who is leading the study - said that it aims to determine whether the medicines make infections more likely or more severe - or, by contrast, whether they help protect against the virus. Suchard said he expects a preliminary report within two weeks.

 

MORE TARGETS FOR THE VIRUS

 

There is evidence that the drugs may increase the presence of an enzyme - ACE2 - that produces hormones that lower blood pressure by widening blood vessels. That’s normally a good thing. But the coronavirus also targets ACE2 and has developed spikes that can latch on to the enzyme and penetrate cells, researchers have found. So more enzymes provide more targets for the virus, potentially increasing the chance of infection or making it more severe.

 

Other evidence, however, suggests the infection’s interference with ACE2 may lead to higher levels of a hormone that causes inflammation, which can result in acute respiratory distress syndrome, a dangerous build-up of fluid in the lungs. In that case, ARBs may be beneficial because they block some of the hormone’s damaging effects.

 

Novartis International AG and Sanofi SA are among the major drugmakers selling ACE inhibitors and ARBs.

 

Sanofi spokesman Nicolas Kressmann said that patients should consult their doctors on whether to continue taking the drugs but that the company has found insufficient evidence that they worsen COVID-19 through its own assessment of available scientific data.

 

The company reviewed several recent studies from China that came to conflicting conclusions about whether COVID-19 patients with hypertension fare worse than other patients, he said.

 

Novartis has not issued any guidance to clinicians or patients and defers to scientists studying the issue, said spokesman Eric Althoff.

 

Researchers and doctors generally agree that people with severe hypertension or heart failure should keep taking the drugs because of the high risks of stopping. The debate centers on how to advise the many patients with milder conditions who take the drugs. Two camps have emerged - one calling for no action unless the drugs are proven dangerous, the other for some limits on their use until they are proven safe.

 

The Centre for Evidence-Based Medicine at University of Oxford in England has recommended that clinicians consider withdrawing the medicines in patients with mild hypertension if they are in a high risk group, such as medical workers - and replacing them with alternative blood pressure-lowering drugs.

 

The New England Journal of Medicine (NEJM) took the opposite tack, highlighting the drugs’ potential in fighting coronavirus and recommending patients continue taking the drugs until more about the risks is known. Several of the scientists who co-authored it had done extensive, industry-supported research on antihypertensive drugs.

 

CONFLICTS OF INTEREST

 

Dr Kevin Kavanagh, founder of Health Watch USA, a patient advocacy organization, questioned whether scientists who are funded by the drug industry should be advising clinicians, given the high stakes.

 

“You need to consider stepping back, and let others without a conflict of interest try to make a call,” Kavanagh said.

 

His organization recommends that doctors temporarily avoid putting new patients on the drugs and warn those currently on them to take extreme precautions to avoid virus exposure.

 

Dr Scott David Solomon, a co-author of the NEJM article, conducts industry-financed research but said it has no influence on his position.

 

“Not only is there no compelling evidence that we should be discontinuing those medications, but there’s reason to think that doing so might actually cause harm,” said Solomon, who is the director of noninvasive cardiology at Brigham and Women’s Hospital in Boston.

 

The lack of consensus leaves doctors to navigate the issue patient by patient. Alexander, of Johns Hopkins, is trying to strike a balance in his own practice. Patients with more severe blood-pressure problems may need to keep taking the medicines, he said, while patients with milder or newly diagnosed cases could instead take one of the “literally dozens” of alternative hypertension treatments.

 

“Rest assured,” he said, “there are dozens of scientific teams working feverishly to put this question to bed.”

 

-- © Copyright Reuters 2020-04-23

 

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[Toany]

It is becoming more important to stay healthy if you want to stay alive. Relying on drug companies to keep you alive is not the answer.

[Baerboxer]

59 minutes ago, Toany said:

It is becoming more important to stay healthy if you want to stay alive. Relying on drug companies to keep you alive is not the answer.

 

I take 4 different tablets a day. Including one for hypertension. Without that I would almost certainly have a very high risk of stroke or heart attack or both. 

 

I rarely drink alcohol, don't smoke, have changed by diet and exercise hard 3 - 4 times a week with some activity every day.

 

But without those drugs, nothing I do or change, can control that hypertension. Genetic. 

 

Reading this, it seems the professionals are split between whether these drugs make are beneficial or negative in Corvid 19 infections. More research is needed.

[VBF]

1 hour ago, Baerboxer said:

 

I take 4 different tablets a day. Including one for hypertension. Without that I would almost certainly have a very high risk of stroke or heart attack or both. 

 

I rarely drink alcohol, don't smoke, have changed by diet and exercise hard 3 - 4 times a week with some activity every day.

 

But without those drugs, nothing I do or change, can control that hypertension. Genetic. 

 

Reading this, it seems the professionals are split between whether these drugs make are beneficial or negative in Corvid 19 infections. More research is needed.

Similar here - BP drugs + ACE inhibitor + Beta Blocker daily.

At present, as the drugs I'm taking are proven to assist with my existing condition and the Covid link is, as yet, unproven I'll carry on "taking the tablets"

 

But eventually might come the question "would I prefer another heart attack / stroke or to get Covid?"

Not a choice I really want to make but.........????  As you say, more research is needed.

Edited April 24, 2020 by VBF

[onebir]

The largest study on the effects of ACEi/ARBs on COVID-19 to date has shown a neutral or protective effect:

 

Quote

Today we have a larger study (open access) that seems to confirm that. It’s a retrospective look from the Wuhan area at 1128 coronavirus patients, 188 of them who were taking drugs in those two classes and 940 of them who were not, median age 64, 53% men.

The unadjusted mortality rate between the two groups was certainly different: 9.8% death in the larger group versus 3.7% in the ACE-I/ARB group. This effect persists after a more thorough comparison, adjusting for age, gender, comorbidities and other medications. In fact, it appears that no matter how you slice the data, what subgroups you’re looking at, ACE inhibitors or angiotensin receptor blockers had significant benefit, and that goes for the head-to-head comparison with other hypertension drugs as well.

https://blogs.sciencemag.org/pipeline/archives/2020/04/20/good-news-on-the-coronavirus-angiotensin-connection

 

The previous smaller study showed a neutral effect. So "keep taking your hypertension meds and carry on" folks ????

 

[unblocktheplanet]

Yup. "Several of the scientists who co-authored it had done extensive, industry-supported research on antihypertensive drugs." Of course, they're safe!

[sharksy]

Viagra lowers blood pressure.  I read recently that Viagra may have a use in treatment of Covid-19.

I guess most ThaiVisa subscribers will not have bad Covid-19 symptoms then? ????

[Ray Ban]

On a bit of a different track, does anybody else have the impression that BP readings in SE Asia are higher than back in the western world ? 
In anticipation of a minor op, I recently had BP readings done at two hospitals in Khon Kaen. The first was 159/95, which the surgeon thought was  “no problem” for the op. The second, a few days later, was 152/99, which prompted the surgeon to put me on Cardioplot for the month prior to the op in early January. 
My Thai wife’s mother is a community health worker in our village and has a government- issued small BP machine. The reading on that is 129/75....much more in line with my readings in Australia for most of my life. 
Anybody with similar experience?

Mind you, pales into insignificance compared to a test at the International Hospital in  Pattaya a few years ago when I registered 110/55, taken twice at my insistence, and the young doctor thought that was “fine” as he wrote out scripts for 6 different pills for what was probably just a 3 day flu !

[VBF]

On 4/24/2020 at 8:32 PM, sharksy said:

Viagra lowers blood pressure.  I read recently that Viagra may have a use in treatment of Covid-19.

I guess most ThaiVisa subscribers will not have bad Covid-19 symptoms then? ????

Perhaps  a little breathlessness ????