Despite concerns expressed by some experts, common high blood pressure drugs did not increase the risk of contracting COVID-19 or of developing severe disease in a new study of 12,594 patients.
Published online in the New England Journal of Medicine journal, the study was launched in response to a joint statement issued by the American Heart Association, the American College of Cardiology, and the Heart Failure Society of America. It urgently called for research to answer a question raised by past studies: do high blood pressure (antihypertensive) drugs worsen COVID-19 patient outcomes?
Led by researchers from New York University (NYU) Grossman School of Medicine, the study found no links between treatment with four drug classes – angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta blockers, or calcium channel blockers — and increased likelihood of a positive test for COVID-19.
“Understanding the relationship between these commonly used medications and COVID-19 was a critical public health concern,” said lead investigator Harmony Reynolds, associate director of the Cardiovascular Clinical Research Center at NYU Langone Health. “Our findings should reasure the medical community and patients about the continued use of these commonly prescribed medications, which prevent potentially severe heart events in their own right,” he added.
Further, the study found no substantial increase in risk for more severe illness (intensive care, use of a ventilator, or death) with any of the treatments in patients with the pandemic virus. The study revolves around drugs that act on the renin-angiotensin-aldosterone hormonal system, which influences blood pressure.
Central to this system is the signaling protein angiotensin II, levels of which are controlled by angiotensin-converting enzyme (ACE). Angiotensin II narrows blood vessels to increase blood pressure, and the study drugs counter that, either by blocking ACE-induced increases in angiotensin II, or the ability of ACE to interact with its receptor signaling partners on cells.
SARS-CoV-2, the current pandemic virus, has been shown to connect to ACE2 on lung cells, a first step toward viral infection. This led to concern in the field that ACE inhibitors and ARBs might increase or worsen COVID-19 infection. Past studies in animal models had suggested that ACE inhibitors and ARBs increase ACE2 production in other organs, but how they related to ACE2 levels in the lungs was not known.
“Before our study, there were no experimental or clinical data demonstrating the consequences of using these medications one way or the other in people at risk for COVID-19,” said senior study author Judith Hochman, Senior Associate Dean for Clinical Sciences at NYU Langone Health.
“In terms of next steps, our plan is to use similar approaches to investigate other medications and their relationship to COVID-19 illness,” he noted.