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March 25 (UPI) -- COVID-19 might interact with heart conditions and blood pressure medications, posing a challenge for physicians managing patients at higher risk for severe illness with the virus, experts said Wednesday. A study published in the journal JAMA Cardiology confirms reports the bug may cause cardiac complications like irregular heartbeat, high blood pressure, myocardial infarction and cardiac arrest.
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Moreover, a review of studies published Tuesday in JAMA Network Open also showed evidence that drugs used to treat these conditions -- angiotensin-converting enzyme, or ACE, inhibitors and angiotensin receptor blockers, or ARBs -- might worsen the virus' effects in some people.
At issue is how the drugs affect ACE2, a protein that has been described as the "entry point" for the new coronavirus into humans. But researchers stress that the research is preliminary, and doctors would be wise to continue current treatment rather than risk making conditions worse -- even without COVID-19.
"A lot of the data we have thus far is stemming from basic science work from earlier coronavirus infections, like SARS in 2003," Dr. Ankit B. Patel, a kidney specialist and fellow at Brigham and Women's Hospital, told UPI. Patel is the co-author of the review of existing studies on links between ACE inhibitors and COVID-19.
"Right now, we don't have enough information on how these medications affect severe disease. What we do know is that ACE inhibitors do not inhibit ACE2, as it's a different enzyme."
According to Patel, while researchers in China suggested that ACE inhibitors and ARBs might increase risk for infection with COVID-19, they are "purely speculative." Connections between the drugs and the virus, he said, may be due to the fact that the conditions they are designed to treat -- like high blood pressure -- seem to predispose some people to the disease.
He noted that similar concerns have been raised about ibuprofen and other so-called non-steroidal anti-inflammatory drugs, or NSAIDs, which do interact with ACE2, despite limited clinical research. It's possible, Patel added, that these drugs may help address the "inflammatory state" caused by the virus.
"Medications like ACE inhibitors or ARBs could either be harmful or beneficial in active infection," he said, adding that they have been shown to reduce inflammation in the heart. "We just don't know."
Still, some physicians are concerned enough with the potential links between these drugs and COVID-19 to urge caution. However, they do not recommend additional screening of these patients for the virus at this time -- nor do they suggest that people stop taking their prescription medications to reduce their risk for infection.
"Patients treated with ACEIs and ARBs for cardiovascular diseases should not stop taking their medicine, but should avoid crowds, mass events, ocean cruises, prolonged air travel and all persons with respiratory illnesses during the current COVID-19 outbreak in order to reduce their risks of infection," Dr. James Diaz, professor of environmental health sciences at LSU Health New Orleans School of Public Health, said in a press release.
He is the author of a review on the subject published earlier this week in the Journal of Travel Medicine.
"Anybody who has high blood pressure, whether or not they're on ACE inhibitors, is at risk," Kathryn A. Boling, a family physician at Mercy Medical Center, told UPI. "At this point, I think it's more dangerous to switch people off medicine that's adequately controlling their blood pressure and causing it to go up than it is to have them stay on their medication until we know for sure."
