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.