Cardiology Organizations Advise on ACE Inhibitors, ARBs Use During COVID-19

In the face of the worldwide coronavirus (COVID-19) pandemic, 4 of the largest cardiology organizations are advising patients receiving treatment with ACE inhibitors (ACE-i) and angiotensin receptor blockers (ARBs) they should not be discontinuing treatment unless it is recommended by their physician.

The European Society of Cardiology (ESC) Council on Hypertension announced their stance in a positioning statement on March 13, and the American College of Cardiology (ACC), American Heart Association (AHA), and Heart Failure Society of America (HFSA) published a joint statement days later on March 17—a move which showed solidarity in opinion between cardiologists, whose patient populations are among the most vulnerable during the outbreak.

“We understand the concern—as it has become clear that people with cardiovascular disease are at much higher risk of serious complications including death from COVID-19," AHA president Robert A. Harrington, MD, said in a statement. "However, we have reviewed the latest research—the evidence does not confirm the need to discontinue ACE-i or ARBs, and we strongly recommend all physicians to consider the individual needs of each patient before making any changes to ACE-i or ARB treatment regimens."

While research surrounding the topic is still limited, the discussion on whether ACE-i and ARBs should be discontinued as part of therapy has mostly been waged by cardiologists on social media. With evidence angiotensin-converting enzyme 2 identified as a functional receptor for SARS-CoV-2, which leads to COVID-19, many have raised the question as to whether it is appropriate to discontinue the aforementioned therapies.

The statement from the ESC Council on Hypertension, which was penned by Giovanni de Simone, MD, Chair of the ESC Council on Hypertension, references the debate taking place on social media and notes the concern this can cause for patients who may read it. The statement goes on to discredit the speculation, citing work in animal studies that suggests these medications might have benefit for preserving lung function.

“This speculation about the safety of ACE-i or ARB treatment in relation to COVID-19 does not have a sound scientific basis or evidence to support it,” Simone and colleagues wrote. “Indeed, there is evidence from studies in animals suggesting that these medications might be rather protective against serious lung complications in patients with COVID-19 infection, but to date there is no data in humans.”

In the event a clinician has a patient with cardiovascular conditions that contracts COVID-19, the joint HFSA/ACC/AHA statement recommends delaying changes in treatment until after a full evaluation is complete. The statement also recommends shared-decision making with the rest of the patient’s care team before going forward with changes to treatment.

“While the primary symptoms of COVID-19 include respiratory symptoms, the latest evidence demonstrates some patients with COVID-19 may also have severe cardiovascular damage," said Biykem Bozkurt, MD, PhD, HFSA president, in the joint statement. "We must ensure we fully evaluate and treat patients with cardiovascular disease."

The joint statement, “HFSA/ACC/AHA statement addresses concerns re: using RAAS antagonists in COVID-19,” was published online in the AHA Newsroom.

The ESC statement, “Position Statement of the ESC Council on Hypertension on ACE-Inhibitors and Angiotensin Receptor Blockers,” was published online in the Council of Hypertension News.