https://www.dailymail.co.uk/news/article-8108735/Medicines-high-blood-pressure-diabetes-worsen-coronavirus-symptoms.htmlMedicines taken by 6.6million people with high blood pressure and diabetes could raise the risk of deadly coronavirus symptoms, scientists claim
ACE inhibitors and angiotensin receptor blockers may lead to worse illness
Patients should not stop taking their medication unless their doctor says so
The pills increase amounts of an enzyme the coronavirus uses to infect the body
Experts said patients with high blood pressure or diabetes should be monitored
Coronavirus symptoms: what are they and should you see a doctor?
By Sam Blanchard Senior Health Reporter For Mailonline
Published: 11:53, 13 March 2020 | Updated: 17:41, 13 March 2020
People with high blood pressure and diabetes could be at higher risk of severe or fatal coronavirus symptoms because of how their medicines work, scientists say. Drugs called ACE inhibitors and angiotensin receptor blockers may change the shape of someone's cells in a way that makes it easier for the coronavirus to infect them and cause more severe illness. The common medications were prescribed almost 65million times in England last year and cost the NHS more than £100m. They are given to treat diabetes or high blood pressure and around 10 percent of people in the UK some 6.6million are estimated to take them regularly. A paper published in the prestigious British medical journal The Lancet Respiratory Medicine studied how the coronavirus latches on to people's cells to infect them. But a doctor has warned that patients who take the medicines must not stop doing so they should speak to their doctor if they have concerns. Scientists say the research does not prove a link between the medications and severe COVID-19, but that a potential connection should be studied more closely. Other risk factors for severe or deadly coronavirus infection include age over-80s are most likely to die and heart disease. People with weak immune systems, such as cancer patients, or those with long-term lung conditions are also at higher risk but are by no means guaranteed to get seriously ill. It comes as the number of confirmed coronavirus patients in the UK has hit 590 and 10 people have died the Government says 5,000-10,000 people may be infected. The article was published by scientists at University Hospital Basel, in Switzerland, and the University of Thessaloniki in Greece. It explains that the coronavirus sticks to cells and attacks them by latching onto something called angiotensin-converting enzyme 2 (ACE2). Some people with high blood pressure or type 1 or type 2 diabetes have to take drugs which increase the amount of ACE2 that they have on their cells, in order to control their illness. There are more than 16million people with these diseases in the UK – but not all patients are given them so the exact number of people taking the drugs is unclear. The drugs the researchers were interested in are called ACE inhibitors and angiotensin receptor blockers (ARBs). The most prescribed versions of these in England are Ramipril, Losartan, Lisinopril, and Candesartan, according to NHS data. Researchers led by Dr. Michael Roth, from the University of Basel, wrote: 'These data suggest that ACE2 expression is increased in diabetes and treatment with ACE inhibitors and ARBs increases ACE2 expression. Consequently, the increased expression of ACE2 would facilitate infection with COVID-19. We, therefore, hypothesise that diabetes and hypertension [high blood pressure] treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19. If this hypothesis were to be confirmed, it could lead to a conflict regarding treatment.'
Professor Tim Chico, from the University of Sheffield, said the article was not evidence of a link between the drugs and a higher risk of dying from the coronavirus. He said: 'This letter does not report the results of a study; it simply raises a possible question about whether a type of blood pressure and heart disease medication called ACE inhibitors might increase the chances of severe COVID19 infections. It does not give any evidence that confirms this, simply it suggests such a relationship should be looked for. It is very important that this letter is not interpreted or reported as saying that ACE inhibitors are proven to worsen COVID19 disease. I strongly advise anyone on heart medications not to stop or change these without discussion with their doctor. If a patient stops their medication and worsens to the point of requiring admission to hospital at the same time as we are dealing with an increase in COVID-19 cases, that would pose the patient a considerable risk and put further strain on the healthcare services.'
Dr. Dipender Gill, who works at Imperial College NHS Trust in London added: 'Evidence is currently lacking and it is too early to make robust conclusions on any link between use of ACE inhibitors and angiotensin II type-I receptor blockers with risk or severity of novel coronavirus disease 2019 (COVID-19) infection. Furthermore, the acute implications of stopping such medications in relation to effects on risk or severity of COVID-19 infection are not known. Patients should be advised to follow public health guidance rather than alter their medications without proper and informed consultation with their medical doctor.'
Dr Roth and his colleagues did their research by looking at other studies of coronavirus patients with severe forms of the illness. They found that the most common illnesses among severely-ill coronavirus patients were high blood pressure (23.7 percent), diabetes (16.2 percent) and heart disease (5.8 percent). And by studying how the coronavirus and SARS, which is almost identical, attach to cells inside people's bodies they came up with a theory of how the blood pressure drugs might make this easier for the viruses. They also added that people with diabetes and high blood pressure might be more at risk because of changes in their genes which makes them produce more ACE2 naturally. They wrote: 'We suggest that patients with cardiac diseases, hypertension [high blood pressure], or diabetes, who are treated with ACE2-increasing drugs, are at higher risk for severe COVID-19 infection and, therefore, should be monitored.'
WHAT ARE THE DRUGS AND ARE THERE ALTERNATIVES?
The drugs mentioned in the paper are called ACE inhibitors and angiotensin receptor blockers (ARBs). Both are used to treat people with high blood pressure and/or diabetes and work by relaxing the arteries, increasing how much blood can flow through them and reducing strain on the heart. In the UK they cost the NHS more than £100million per year, were prescribed around 65million times in 2018, and are taken by millions of people in the UK and US. One cardiologist's estimate suggested around 10 percent of the population takes the medications to some 6.6million people. The most prescribed versions of these in England are Ramipril, Losartan, Lisinopril, and Candesartan, according to NHS data. People who are prescribed these medications should not stop taking them. The scientists' paper is not a study that can prove any link to severe COVID-19 but is a call for more research into a possible connection. Anyone who is concerned about continuing to take their medicine should speak to their doctor. Other blood pressure-lowering drugs do exist and can be used as alternatives in some situations. Medications called calcium channel blockers (CCPs) and diuretics, such as Bendroflumethiazide and Furosemide, can also be used to lower high blood pressure. The type of medicines patients are given depends on their individual condition and not all are interchangeable.
